Apparatus, systems and methods for minimally invasive dissection of tissues

ABSTRACT

Electrosurgical lysing devices and related systems and methods. In some embodiments, the lysing device may comprise a lysing tip comprising a plurality of beads and at least one lysing member, such as a lysing rod, defining at least one lysing segment extending between each pair of adjacent beads. The at least one lysing member may extend through a tunnel extending at least partially through each of the plurality of beads so as to define the at least one lysing segment between each pair of adjacent beads.

RELATED APPLICATIONS

This application claims the benefit under 35 U.S.C. §119(e) of U.S.Provisional Patent Application No. 62/313,707 filed on Mar. 26, 2016 andtitled “Apparatus & Systems For Minimally Invasive Dissection of Tissuesvia Cannula” and further claims the benefit under 35 U.S.C. §119(e) ofU.S. Provisional Patent Application No. 62/409,575 filed on Oct. 18,2016 and titled “Apparatus, Systems, and Methods for Minimally InvasiveDissection of Tissues.” Each of the aforementioned applications isincorporated herein by reference in its entirety.

SUMMARY

Examples of certain preferred embodiments and implementations of theinvention are disclosed below in connection with the following numberedparagraphs.

1. An electrosurgical device configured for deployment through acannula, comprising:

-   -   a lysing tip configured for delivery of electrosurgical energy,        wherein the lysing tip comprises:        -   an energy delivery side configured to receive and deliver            electrosurgical energy for one or both of tissue dissection            and modification; and        -   an orientational-deployment side opposite from the energy            delivery side, wherein the orientational-deployment side is            configured to allow for the lysing tip to be repositioned            between a delivery configuration in which the lysing tip can            be positioned within a lumen of the cannula with the energy            delivery side facing an interior surface of the lumen and a            treatment configuration in which the lysing tip is            positioned outside of the cannula such that the energy            delivery side extends at least substantially perpendicular            to an axis of the cannula; and    -   a deployment assembly coupled with the orientational-deployment        side of the lysing tip, wherein the deployment assembly is        configured to allow for selective repositioning between the        delivery configuration and the treatment configuration.

2. The electrosurgical device of example 1, wherein the lysing tip isconfigured is configured such that the energy delivery side extends atleast substantially parallel to the axis of the cannula in the deliveryconfiguration.

3. The electrosurgical device of example 1, wherein the lysing tip isconfigured such that the energy delivery side extends at an acute anglerelative to the axis of the cannula in the delivery configuration.

4. The electrosurgical device of example 1, wherein the deploymentassembly comprises a first actuation rod and a second actuation rodcoupled with the lysing tip.

5. The electrosurgical device of example 4, further comprising aretraction guide configured to facilitate repositioning of the lysingtip between the treatment configuration and the delivery configuration.

6. The electrosurgical device of example 5, wherein the retraction guideis configured to provide a restorative force to the lysing tip bycontacting the cannula when the lysing tip is repositioned from thetreatment configuration to the delivery configuration.

7. The electrosurgical device of example 6, wherein the retraction guidecomprises a spring positioned on at least one of the first actuation rodand the second actuation rod.

8. The electrosurgical device of example 4, further comprising at leastone canal configured to supply fluids to a surgical site adjacent to thelysing tip during a surgical procedure.

9. The electrosurgical device of example 8, wherein the at least onecanal is configured to be selectively extended towards the lysing tipand withdrawn from the lysing tip.

10. The electrosurgical device of example 4, wherein the first actuationrod comprises a first hinge, and wherein the second actuation rodcomprises a second hinge.

11. The electrosurgical device of example 10, wherein the first hingeand the second hinge are configured to allow the lysing tip to beselectively rotated at least one of above and below a cross-sectionalprofile of an opening at a distal end of the cannula in the treatmentconfiguration.

12. The electrosurgical device of example 1, further comprising at leastone energy window formed on at least one of an upper surface and a lowersurface of the lysing tip.

13. The electrosurgical device of example 12, wherein the at least oneenergy window comprises a plurality of energy windows.

14. The electrosurgical device of example 13, wherein at least a subsetof the plurality of energy windows are at least one of physically andenergetically isolated from one another.

15. The electrosurgical device of example 14, wherein the at least asubset of the plurality of energy windows is configured to deliver amodality of energy that differs from at least a second subset of theplurality of energy windows.

16. The electrosurgical device of example 1, wherein the lysing tipcomprises an antenna configured to provide location data regarding thelysing tip.

17. The electrosurgical device of example 16, wherein the antennacomprises an RFID tag.

18. The electrosurgical device of example 1, wherein the lysing tipcomprises a bipolar lysing tip configured to deliver bipolarelectrosurgical energy, and wherein the lysing tip comprises a first setof lysing elements and a second set of lysing elements, wherein thefirst set of lysing elements is electrically isolated from the secondset of lysing elements.

19. The electrosurgical device of example 18, wherein the lysing tipcomprises a first linking member electrically coupled to the first setof lysing elements and a second linking member electrically coupled tothe second set of lysing elements, and wherein the first linking memberis electrically isolated from the second linking member.

20. An electrosurgical system, comprising:

-   -   an electrosurgical device comprising a lysing tip having a first        end and a second end opposite from the first end, wherein the        lysing tip comprises:        -   a plurality of protrusions; and        -   at least one lysing segment positioned between at least two            adjacent protrusions in the plurality of protrusions;    -   a cannula configured for delivery of the electrosurgical device;        and    -   a deployment assembly coupled with the electrosurgical device,        wherein the electrosurgical device and the deployment assembly        are configured such that the at least one lysing segment is        positioned to face an interior wall of the cannula during        delivery of the electrosurgical device, and such that the at        least one lysing segment can be rotated after extending through        a distal end of the cannula to allow at least one of the first        end and the second end to protrude beyond a cross-sectional        profile of an opening at the distal end.

21. The electrosurgical system of example 20, wherein theelectrosurgical device and the deployment assembly are configured suchthat the at least one lysing segment can be rotated after extendingthrough a distal end of the cannula to allow both the first end and thesecond end of the lysing tip to protrude beyond a cross-sectionalprofile of the opening at the distal end.

22. The electrosurgical system of example 20, further comprising asecond cannula comprising a cross-sectional area greater than across-sectional area of the cannula, wherein the second cannula isconfigured to be positioned outside the cannula during delivery of theelectrosurgical device.

23. The electrosurgical system of example 22, wherein theelectrosurgical device is configured such that the plurality ofprotrusions is unable to be fully received within the second cannula.

24. The electrosurgical system of example 20, further comprising a spotcoagulator configured to extend through the cannula and deliverelectrosurgical energy therethrough.

25. The electrosurgical system of example 24, wherein the spotcoagulator is configured to be selectively movable relative to thelysing tip.

26. The electrosurgical system of example 20, further comprising meansfor fixing a rotational orientation of the lysing tip relative to thecannula.

27. The electrosurgical system of example 26, wherein the means forfixing a rotational orientation of the lysing tip relative to thecannula is positioned on the cannula.

28. The electrosurgical system of example 26, wherein the means forfixing a rotational orientation of the lysing tip relative to thecannula comprises at least one slot formed in a distal end of thecannula.

29. The electrosurgical system of example 28, wherein the at least oneslot is configured to receive at least a portion of the lysing tiptherein in a treatment configuration in which the lysing tip ispositioned outside of the cannula such that the energy delivery sideextends at least substantially perpendicular to the axis of the cannula.

30. The electrosurgical system of example 20, wherein the at least onelysing segment is made up of a cermet material.

31. The electrosurgical system of example 20, wherein the deploymentassembly comprises:

-   -   a first actuation rod; and    -   an intermediate hinge member coupled with the first actuation        rod and coupled with the lysing tip, wherein the intermediate        hinge member is configured such that actuation of the first        actuation rod results in pivoting of the lysing rod between a        delivery configuration in which the lysing tip can be positioned        within a lumen of the cannula with the at least one lysing        segment facing an interior surface of the lumen and a treatment        configuration in which the lysing tip is positioned with at        least one of the first end and the second end protruding beyond        a cross-sectional profile of the opening of the cannula at the        distal end.

32. The electrosurgical system of example 31, wherein the intermediatehinge member is coupled with the lysing tip in between two opposing endsof the lysing tip.

33. The electrosurgical system of example 32, wherein the lysing tipfurther comprising a linking member positioned along a proximal side ofthe lysing tip, and wherein the intermediate hinge member is coupledwith the linking member.

34. The electrosurgical system of example 32, wherein the deploymentassembly further comprises a second actuation rod.

35. The electrosurgical system of example 34, wherein the secondactuation rod is pivotably coupled to the lysing tip.

36. The electrosurgical system of example 35, wherein the secondactuation rod is pivotably coupled to the lysing tip at one end of thetwo opposing ends of the lysing tip.

37. The electrosurgical system of example 31, wherein the intermediatehinge member is coupled with the lysing tip at one end of two opposingends of the lysing tip.

38. The electrosurgical system of example 37, wherein the deploymentassembly further comprises a second actuation rod.

39. The electrosurgical system of example 38, wherein the secondactuation rod is configured to advance and withdraw the lysing tipwithin the cannula.

40. The electrosurgical system of example 39, wherein the secondactuation rod is coupled with the lysing tip along a central portion ofthe lysing tip between the two opposing ends.

41. A surgical system, comprising:

-   -   a surgical lysing tip comprising:        -   a treatment side; and        -   an orientational-deployment side opposite from the treatment            side, wherein the surgical lysing tip comprises a lysing tip            axis extending at least substantially along the treatment            side and along the orientational-deployment side;    -   a cannula configured for delivery of the surgical lysing tip,        wherein the cannula comprises a cannula axis; and    -   a deployment assembly coupled with the orientational-deployment        side of the surgical lysing tip and configured to pivot the        surgical lysing tip following delivery of the surgical lysing        tip through a distal opening of the cannula, wherein the        deployment assembly is configured to allow the surgical lysing        tip to be delivered through the cannula along the cannula axis        such that the lysing tip axis is at least substantially aligned        with the cannula axis during delivery, and wherein the        deployment assembly is configured to allow the surgical lysing        tip to be selectively pivoted after the surgical lysing tip has        passed through the distal opening such that the lysing tip axis        is positioned at an angle with respect to the cannula axis and        such that at least one of two opposing ends of the surgical        lysing tip defining the lysing tip axis protrudes beyond a        cross-sectional profile of the distal opening of the cannula.

42. The surgical system of example 41, wherein the surgical system isconfigured to allow the surgical lysing tip to be selectively pivotedafter the surgical lysing tip has passed through the distal opening suchthat the lysing tip axis is positioned at an angle with respect to thecannula axis and such that both of the two opposing ends of the surgicallysing tip defining the lysing tip axis protrude beyond thecross-sectional profile of the distal opening of the cannula.

43. An electrosurgical device, comprising:

-   -   a lysing tip comprising:        -   a plurality of beads;        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads; and        -   a tunnel extending at least partially through each of the            plurality of beads, wherein the at least one lysing member            is positioned to extend at least partially through the            tunnel to define the at least one lysing segment between            each pair of adjacent beads.

44. The electrosurgical device of example 43, wherein each of theplurality of beads is non-symmetrical relative to an axis defined by theat least one lysing member.

45. The electrosurgical device of example 43, wherein the lysing tipcomprises a plurality of lysing segments.

46. The electrosurgical device of example 44, wherein each of theplurality of lysing segments is formed by a single lysing member.

47. The electrosurgical device of example 44, wherein at least onelysing segment of the plurality of lysing segments extends at an anglerelative to at least one other lysing segment of the plurality of lysingsegments.

48. The electrosurgical device of example 47, wherein the plurality oflysing segments extend in an arced shape along a treatment side of thelysing tip.

49. The electrosurgical device of example 48, wherein at least a firstlysing segment of the plurality of lysing segments extends in a firstdirection, wherein at least a second lysing segment of the plurality oflysing segments extends in a second direction angled towards a firstside of the lysing tip relative to the first direction, and wherein atleast a third lysing segment of the plurality of lysing segments extendsin a third direction angled towards a second side of the lysing tipopposite from the first side relative to the first direction.

50. The electrosurgical device of example 43, wherein each of at least asubset of the plurality of beads comprises a plurality of facets formedthereon.

51. The electrosurgical device of example 50, wherein each of the atleast a subset of the plurality of beads comprises facets formed onleading surfaces of the beads, and wherein the facets are configured tofacilitate movement of the lysing tip between tissue layers during asurgical procedure.

52. The electrosurgical device of example 51, wherein each of the atleast a subset of the plurality of beads comprises a first facet formedon an upper leading surface and a second fact formed on a lower leadingsurface, and wherein the upper leading surface is angled towards thelower leading surface so as to form a wedge shape.

53. The electrosurgical device of example 43, wherein each of at least asubset of the plurality of beads comprises a substantially flattenedtrailing end.

54. The electrosurgical device of example 53, wherein the at least asubset of the plurality of beads comprises a substantiallyfrusto-ellipsoidal shape.

55. The electrosurgical device of example 43, wherein each of at least asubset of the plurality of beads comprises a substantially ellipsoidalshape.

56. The electrosurgical device of example 55, wherein each of theplurality of beads comprises a substantially ellipsoidal shape.

57. The electrosurgical device of example 43, further comprising a firstactuation rod coupled adjacent to a first end of the lysing tip and asecond actuation rod coupled adjacent to a second end of the lysing tipopposite from the first end.

58. The electrosurgical device of example 57, wherein the firstactuation rod and the second actuation rod are configured to pivot thelysing tip between a delivery configuration and a treatmentconfiguration.

59. The electrosurgical device of example 58, wherein the lysing tip isconfigured to be delivered through a cannula with the first actuationrod and the second actuation rod extending through the cannula, whereinthe electrosurgical device is configured such that the lysing tip cannotbe fully received in the cannula in the treatment configuration.

60. The electrosurgical device of example 59, wherein theelectrosurgical device is configured so as to extend the lysing tip atan angle relative to an axis of the cannula in the deliveryconfiguration, and wherein the electrosurgical device is configured suchthat the lysing tip can be fully received in the cannula in the deliveryconfiguration.

61. The electrosurgical device of example 60, wherein at least one ofthe first actuation rod and the second actuation rod comprises a firstbend at or near a distal end of the at least one of the first actuationrod and the second actuation rod.

62. The electrosurgical device of example 61, wherein the first benddefines a widened area for receipt of a portion of the lysing tip duringrepositioning of the lysing tip between the treatment configuration andthe delivery configuration.

63. The electrosurgical device of example 62, wherein the at least oneof the first actuation rod and the second actuation rod comprises asecond bend positioned distally of the first bend, and wherein thesecond bend extends in a direction opposite of the first bend.

64. The electrosurgical device of example 58, wherein the firstactuation rod comprises a first opening for receiving a first end of thelysing member therethrough, and wherein the second actuation rodcomprises a second opening for receiving a second end of the lysingmember opposite from the first end therethrough.

65. The electrosurgical device of example 64, wherein the first openingis elongated to allow the lysing member to pivot within the firstopening as the lysing tip is repositioned between the treatmentconfiguration and the delivery configuration.

66. The electrosurgical device of example 65, wherein the first openingis elongated at least substantially in a direction of an axis of thefirst actuation rod.

67. The electrosurgical device of example 43, wherein at least a subsetof the plurality of beads is configured to rotate about the at least onelysing member.

68. The electrosurgical device of example 67, wherein the at least asubset of the plurality of beads is configured to rotate in an upwarddirection relative to the lysing tip within a range of between about 2degrees and about 110 degrees, and wherein the at least a subset of theplurality of beads is configured to rotate in a downward directionrelative to the lysing tip within a range of between about 2 degrees andabout 110 degrees.

69. The electrosurgical device of example 67, wherein each of theplurality of beads is configured to be independently rotatable about theat least one lysing member with respect to the other beads of theplurality of beads.

70. The electrosurgical device of example 64, wherein the first openingcomprises internal beveling adjacent to the first opening, and whereinthe internal beveling is configured to facilitate pivoting of the lysingtip between the treatment configuration and the delivery configuration.

71. The electrosurgical device of example 43, further comprising:

-   -   a first coupling tip at a first end of the at least one lysing        member; and    -   a second coupling tip at a second end of the at least one lysing        member opposite from the first end, wherein the first coupling        tip and the second coupling tip are configured to secure the at        least one lysing member to two outermost beads of the plurality        of beads.

72. The electrosurgical device of example 71, wherein the first couplingtip differs from the second coupling tip.

73. The electrosurgical device of example 71, wherein the first couplingtip comprises a weld defining a cross-sectional dimension greater in atleast one direction that a cross-sectional dimension of the at least onelysing member.

74. The electrosurgical device of example 43, further comprising aplurality of spacers coupled with the at least one lysing member,wherein each of the plurality of spacers is positioned between twoadjacent beads of the plurality of beads.

75. The electrosurgical device of example 74, wherein the at least onelysing member comprises a single lysing rod.

76. The electrosurgical device of example 75, wherein the single lysingrod comprises a circular shape in cross section.

77. The electrosurgical device of example 75, wherein each of theplurality of spacers comprises an opening configured to receive aportion of the single lysing rod therethrough.

78. The electrosurgical device of example 77, wherein the single lysingrod has a cross-sectional shape that differs from a cross-sectionalshape of an exterior surface of each of the plurality of spacers.

79. The electrosurgical device of example 74, wherein each of theplurality of spacers comprises a leading edge for delivery ofelectrosurgical energy from the at least one lysing member.

80. The electrosurgical device of example 79, wherein each of theplurality of spacers comprises only a single edge.

81. The electrosurgical device of example 80, wherein, other than thesingle edge, each of the plurality of spacers comprises an at leastsubstantially smooth exterior surface such that at least substantiallyall of the electrosurgical energy from the at least one lysing member isdelivered through the single edge.

82. The electrosurgical device of example 74, wherein each of theplurality of spacers comprises a conductive material such thatelectrosurgical energy from the at least one lysing member can bedelivered through the spacers.

83. The electrosurgical device of example 74, wherein each of theplurality of spacers comprises an insulating material, and wherein eachof the plurality of spacers comprises one or more openings configured toallow for delivery of electrosurgical energy through the one or moreopenings.

84. The electrosurgical device of example 74, wherein the at least onelysing member comprises a lysing rod having a circular cross-sectionalshape, and wherein each of the plurality of spacers is crimped onto thelysing rod in between two adjacent beads of the plurality of beads.

85. The electrosurgical device of example 74, wherein the spacers areconfigured to at least substantially prevent rotation of the pluralityof beads with respect to the at least one lysing member.

86. The electrosurgical device of example 74, wherein the spacers areconfigured to selectively limit an amount of rotation of the pluralityof beads with respect to the at least one lysing member.

87. The electrosurgical device of example 43, further comprising aplurality of protuberances formed on the at least one lysing member,wherein the plurality of protuberances are configured to confine each ofthe plurality of beads to a predetermined region relative to the atleast one lysing member.

88. The electrosurgical device of example 87, wherein the plurality ofprotuberances comprise welds formed on the at least one lysing member.

89. The electrosurgical device of example 43, wherein the at least onelysing member comprises a single lysing rod.

90. The electrosurgical device of example 89, wherein the lysing rodcomprises a leading edge for delivery of electrosurgical energy.

91. The electrosurgical device of example 90, wherein the lysing rodcomprises only a single edge.

92. The electrosurgical device of example 91, wherein, other than thesingle edge, the lysing rod comprises an at least substantially smoothexterior surface.

93. The electrosurgical device of example 89, wherein the lysing rodcomprises a polygonal shape in cross section.

94. The electrosurgical device of example 93, wherein the lysing rodcomprises at least one of a pentagonal and a hexagonal shape in crosssection.

95. The electrosurgical device of example 43, wherein each of theplurality of beads comprises an identical shape.

96. The electrosurgical device of example 43, wherein two opposing outerbeads of the plurality of beads comprise a first shape, and wherein atleast one inner bead of the plurality of beads comprises a second shapethat differs from the first shape.

97. The electrosurgical device of example 43, wherein each of at least asubset of the plurality of beads comprises a substantially ellipsoidalshape.

98. The electrosurgical device of example 43, wherein each of at least asubset of the plurality of beads comprises an annular bead structure.

99. The electrosurgical device of example 98, wherein each of the atleast a subset of the plurality of beads comprises a bead hub positionedwithin the annular bead structure.

100. The electrosurgical device of example 99, wherein each of the beadhubs is configured to couple the bead with the at least one lysingmember.

101. The electrosurgical device of example 43, wherein each of at leasta subset of the plurality of beads comprises a trailing end and aleading end, wherein the trailing end comprises a rougher surface thanthe leading end.

102. An electrosurgical device, comprising:

-   -   a lysing tip comprising a treatment side and an        orientational-deployment side opposite from the treatment side,        wherein the lysing tip further comprises:        -   a plurality of beads; and        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads,            wherein the at least one lysing segment defines a coupling            axis with the plurality of beads, and wherein the lysing tip            comprises an open region lacking structure on the            orientational-deployment side such that at least some of the            plurality of beads protrudes from the treatment side and            from the orientational-deployment side of the lysing tip.

103. An electrosurgical device, comprising:

-   -   a lysing tip comprising a treatment side and an        orientational-deployment side opposite from the treatment side,        wherein the lysing tip further comprises:        -   a plurality of beads;        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads,            wherein the at least one lysing segment defines a coupling            axis with the plurality of beads; and        -   a support member extending between a first outer bead of the            plurality of beads and a second outer bead of the plurality            of beads opposite from the first outer bead on the            orientational-deployment side, wherein the support member is            configured to facilitate coupling of the lysing tip to a            surgical tool used to control the lysing tip during a            surgical procedure within a patient's body.

104. The electrosurgical device of example 103, further comprising agrasping pad configured to engage at least one jaw of the surgical tool.

105. The electrosurgical device of example 104, wherein at least aportion of the grasping pad is electrically coupled to the at least onelysing member such that the grasping pad is configured to receiveelectrosurgical energy from the surgical tool and transfer theelectrosurgical energy to the at least one lysing segment.

106. The electrosurgical device of example 104, wherein the grasping padis formed on the support member.

107. The electrosurgical device of example 105, wherein the grasping padcomprises a hole configured to receive a projection extending from theat least one jaw of the surgical tool.

108. The electrosurgical device of example 107, wherein the grasping padis coated with an insulating coating, wherein the hole is uncoated, andwherein the at least a portion of the grasping pad comprises the hole.

109. An electrosurgical system, comprising:

-   -   a lysing tip comprising a treatment side and an        orientational-deployment side opposite from the treatment side,        wherein the lysing tip further comprises:        -   a plurality of beads;        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads,            wherein the at least one lysing member defines a coupling            axis with the plurality of beads; and        -   a cannula configured for delivery of the lysing tip            therethrough into a patient's body, wherein the cannula            comprises a cannula axis, and wherein the system is            configured such that the lysing tip can be delivered through            the cannula with the coupling axis aligned with the cannula            axis.

110. The electrosurgical system of example 109, further comprising asecond cannula, wherein the second cannula comprises a lumen having asmaller cross-sectional dimension that the cannula such that the secondcannula can fit within the cannula, and wherein the lysing tip isconfigured such that the plurality of beads is unable to be fullyreceived within the second cannula with the coupling axis aligned withthe cannula axis.

111. An electrosurgical system, comprising:

-   -   a lysing tip comprising a treatment side and an        orientational-deployment side opposite from the treatment side,        wherein the lysing tip further comprises:        -   a plurality of beads;        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads,            wherein the lysing tip comprises a primary axis extending            between a first outer bead of the plurality of beads and a            second outer bead of the plurality of beads, and wherein            each of the plurality of beads comprises a tip extending at            least substantially perpendicular to the primary axis; and        -   a cannula configured for delivery of the lysing tip            therethrough into a patient's body, wherein the cannula            comprises a cannula axis, and wherein the system is            configured such that the lysing tip can be delivered through            the cannula with the primary axis aligned with the cannula            axis.

112. An electrosurgical system, comprising:

-   -   a lysing tip comprising a treatment side and a grasping pad        opposite from the treatment side, wherein the treatment side is        configured to receive and deliver electrosurgical energy for        tissue one or both of dissection and modification; and    -   a first instrument configured to selectively couple with the        lysing tip, wherein the first instrument is configured to        deliver electrosurgical energy to the treatment side of the        lysing tip while the lysing tip is coupled with the first        instrument, and wherein the first instrument is configured to        selectively couple with the lysing tip at the grasping pad.

113. The electrosurgical system of example 112, wherein the lysing tipcomprises:

-   -   a plurality of protrusions;    -   at least one lysing member defining at least one lysing segment        between each pair of adjacent protrusions of the plurality of        protrusions.

114. The electrosurgical system of example 112, wherein the lysing tipfurther comprises:

-   -   a plurality of beads; and    -   a lysing rod extending at least partially through each of the        plurality of beads so as to define a plurality of lysing        segments extending between adjacent beads of the plurality of        beads.

115. The electrosurgical system of example 114, wherein the lysing tipfurther comprises a support member coupled to the lysing rod at oppositeends of the support member.

116. The electrosurgical system of example 115, wherein the lysing tipfurther comprises a grasping pad formed on the support member, andwherein the first instrument comprises at least one jaw configured toengage the grasping pad.

117. The electrosurgical system of example 116, wherein the at least onejaw comprises an upper jaw and a lower jaw, and wherein at least one ofthe upper jaw and the lower jaw is movable such that the upper jaw andthe lower jaw are configured to open to receive the grasping pad and toclose to fixedly couple the grasping pad in between the upper jaw andthe lower jaw.

118. The electrosurgical system of example 116, wherein the at least onejaw comprises a projection, wherein the grasping pad comprises anopening configured to receive the projection.

119. The electrosurgical system of example 118, wherein the firstinstrument is configured to deliver electrosurgical energy from theprojection, through the opening, and into the lysing rod.

120. The electrosurgical system of example 119, wherein the grasping padcomprises a non-conductive insulation, and wherein the at least one jawcomprises a non-conductive insulation.

121. The electrosurgical system of example 120, wherein the projectionlacks the non-conductive insulation, and wherein the opening lacks thenon-conductive insulation.

122. The electrosurgical system of example 120, wherein thenon-conductive insulation comprises a coating.

123. The electrosurgical system of example 113, wherein the plurality ofprotrusions comprises a plurality of beads positioned along the at leastone lysing member.

124. The electrosurgical system of example 114, wherein each of theplurality of beads is independently movable at least one of laterallyand rotationally with respect to the at least one lysing member.

125. The electrosurgical system of example 114, wherein at least asubset of the plurality of beads protrudes both distally in a directionof the treatment side and proximally in a direction opposite of thedirection of the treatment side relative to the at least one lysingmember.

126. The electrosurgical system of example 114, wherein each of theplurality of beads protrudes both distally in a direction of thetreatment side and proximally in a direction opposite of the directionof the treatment side relative to the at least one lysing member.

127. The electrosurgical system of example 112, wherein the firstinstrument comprises a jaw configured to receive the grasping pad of thelysing tip to couple the lysing tip to the first instrument.

128. The electrosurgical system of example 127, wherein the grasping padcomprises a magnet, and wherein the jaw comprises a magnetic elementconfigured to engage the magnet.

129. The electrosurgical system of example 127, wherein the jawcomprises an insulated exterior surface, and wherein at least a portionof an interior surface of the jaw configured to engage the grasping padis uninsulated to allow for delivery of electrosurgical energy throughthe jaw to the grasping pad and to the treatment side of the lysing tip.

130. The electrosurgical system of example 127, wherein the jaw isconfigured to open to facilitate receiving the grasping pad, and whereinthe jaw is configured to close to grasp the grasping pad.

131. The electrosurgical system of example 127, wherein the jawcomprises a projection, wherein the grasping pad comprises a hole, andwherein the projection is configured to be received in the hole tofacilitate a more stable coupling of the lysing tip with the firstinstrument.

132. The electrosurgical system of example 131, wherein the jaw isinsulated, and wherein the projection is uninsulated to allow fordelivery of electrosurgical energy through the projection to thegrasping pad and to the treatment side of the lysing tip.

133. The electrosurgical system of example 112, further comprising asecond instrument configured to facilitate coupling of the lysing tip tothe first instrument.

134. The electrosurgical system of example 133, further comprising:

-   -   a first cannula configured to deliver the first instrument and        the lysing tip into a patient's body; and    -   a second cannula configured to deliver the second instrument        into the patient's body.

135. The electrosurgical system of example 133, wherein the secondinstrument lacks the ability to deliver electrosurgical energy.

136. The electrosurgical system of example 133, wherein the firstinstrument comprises a jaw, wherein the second instrument comprises ajaw, and wherein the jaw of the first instrument is identical to the jawof the second instrument.

137. The electrosurgical system of example 112, further comprising afirst cannula configured to deliver the first instrument and the lysingtip into a patient's body.

138. The electrosurgical system of example 112, further comprising alinking member positioned opposite from the treatment side, wherein thelinking member is configured to facilitate coupling of the lysing tipwith the first instrument.

139. The electrosurgical system of example 138, wherein the grasping padextends from the linking member.

140. The electrosurgical system of example 112, wherein the firstinstrument comprises at least one of means for grasping the lysing tipand means for controlling the lysing tip during a surgical procedure.

141. The electrosurgical system of example 140, wherein the firstinstrument comprises means for grasping the lysing tip, and wherein themeans for grasping the lysing tip comprises a pair of jaws configured toreceive the grasping pad.

142. The electrosurgical system of example 141, wherein at least one jawof the pair of jaws is movable.

143. The electrosurgical system of example 112, further comprising atether coupled with the lysing tip, wherein the tether is configured tofacilitate coupling of the lysing tip with the first instrument.

144. The electrosurgical system of example 143, wherein the tether iscoupled with the grasping pad of the lysing tip.

145. The electrosurgical system of example 144, wherein the firstinstrument comprises a jaw configured to receive the grasping pad of thelysing tip to couple the lysing tip to the first instrument, and whereinthe tether extends through an opening formed in the jaw.

146. The electrosurgical system of example 143, wherein the tether isconfigured to, upon being retracted, direct the lysing tip into anengagement feature of the first instrument.

147. The electrosurgical system of example 146, wherein the engagementfeature comprises a jaw.

148. The electrosurgical system of example 112, wherein the firstinstrument comprises at least one jaw, wherein the at least one jaw isconfigured to engage the grasping pad of the lysing tip, and wherein thesystem is configured such that the first instrument deliverselectrosurgical energy from the at least one jaw, through the graspingpad, and into a plurality of lysing segments on the treatment side.

149. The electrosurgical system of example 148, further comprising aslot formed in the at least one jaw, wherein the slot is configured toreceive at least a portion of the grasping pad.

150. The electrosurgical system of example 149, wherein the at least onejaw is configured to open and shut, and wherein the slot is configuredto enclose the grasping pad about at least 3 sides of the grasping padand at least partially about a fourth side of the grasping pad when theat least one jaw is closed with the grasping pad positioned therein.

151. The electrosurgical system of example 149, wherein the at least onejaw comprises at least one of an insulating cover and an insulatingcoating, and wherein at least a portion of the slot lacks the at leastone of an insulating cover and an insulating coating so as to allow fortransfer of electrosurgical energy therethrough.

152. A method for use of an electrosurgical device, the methodcomprising the steps of:

-   -   delivering a lysing tip through a first cannula into a patient's        body;    -   advancing the lysing tip beyond a distal opening of the first        cannula;    -   delivering a first instrument through a second cannula into the        patient's body adjacent to the lysing tip;    -   coupling the lysing tip with the first instrument;    -   advancing a second instrument through the first cannula into the        patient's body such that at least a distal end of the second        instrument protrudes beyond the distal opening of the first        cannula;    -   using the first instrument to couple the lysing tip with the        second instrument;    -   releasing the lysing tip from the first instrument; and    -   using the second instrument to perform a surgical procedure with        the lysing tip.

153. The method of example 152, wherein the second instrument comprisesat least one jaw configured to engage a first portion of the lysing tip,and wherein the step of using the first instrument to couple the lysingtip with the second instrument comprises advancing the first portion ofthe lysing tip into the at least one jaw.

154. The method of example 153, wherein the step of using the firstinstrument to couple the lysing tip with the second instrument furthercomprises closing the at least one jaw to secure the first portion ofthe lysing tip therein.

155. The method of example 153, wherein the first portion of the lysingtip comprises a grasping pad protruding from a proximal side of thelysing tip.

156. The method of example 155, wherein lysing tip comprises an energydelivery side opposite from the proximal side, and wherein the secondinstrument is configured to deliver electrosurgical energy through thegrasping pad to the energy delivery side when the second instrument iscoupled with the lysing tip.

157. The method of example 153, wherein the first instrument comprisesat least one jaw configured to engage a second portion of the lysing tipdistinct from the first portion.

158. The method of example 148, wherein the step of advancing the lysingtip beyond a distal opening of the first cannula is performed using thesecond instrument.

159. The method of example 148, wherein the second instrument isconfigured to deliver electrosurgical energy to the lysing tip when thesecond instrument is coupled with the lysing tip.

160. The method of example 159, wherein the first instrument lacks theability to deliver electrosurgical energy.

161. An electrosurgical system, comprising:

-   -   a lysing tip comprising a treatment side and an        orientational-deployment side opposite from the treatment side,        wherein the lysing tip further comprises:        -   a plurality of beads, wherein each of the plurality of beads            extends from the treatment side towards the            orientational-deployment side, and wherein the plurality of            beads collectively defines a lysing tip axis extending            between two outer beads of the plurality of beads; and        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads,            wherein the at least one lysing member defines a coupling            axis with the plurality of beads;    -   a cannula comprising a lumen configured to deliver the lysing        tip therethrough; and    -   at least one actuation rod coupled with the lysing tip, wherein        the at least one actuation rod is configured to reorient the        lysing tip between a delivery configuration in which the lysing        tip axis extends through the lumen and a treatment configuration        in which the lysing tip axis extends at least substantially        perpendicular to an axis of the lumen outside of a distal end of        the cannula.

162. The system of example 161, wherein the lysing tip comprises an openregion lacking structure on the orientational-deployment side proximalto the at least one lysing member and the plurality of beads.

163. The system of example 161, wherein the lysing tip is configuredsuch that at least a subset of the plurality of beads protrude from thetreatment side and at least a subset of the plurality of beads protrudefrom the orientational-deployment side.

164. The system of example 161, wherein the at least one lysing membercomprises a lysing plate, and wherein the lysing plate extends along thelysing tip axis.

165. The system of example 164, wherein the lysing tip is configuredsuch that the lysing plate extends through each of the plurality ofbeads, and such that the lysing plate alone supports each of theplurality of beads on the lysing tip.

166. The system of example 161, wherein the electrosurgical system isconfigured such that the lysing tip axis extends at least substantiallyparallel to the axis of the lumen in the delivery configuration.

167. The system of example 161, wherein the electrosurgical system isconfigured such that at least one of the two outer beads of theplurality of beads extends beyond a cross-sectional profile of anopening at the distal end of the cannula in the treatment configuration.

168. The system of example 167, where the electrosurgical system isconfigured such that both of the two outer beads of the plurality ofbeads extends beyond a cross-sectional profile of an opening at thedistal end of the cannula in the treatment configuration.

169. The system of example 161, further comprising a second cannula,wherein the second cannula comprises a lumen having a smallercross-sectional size than the cannula, and wherein the second cannula isconfigured to be received within the cannula.

170. The system of example 169, wherein the lysing tip is configuredsuch that none of the plurality of beads is configured to be fullyreceived within the second cannula in either the delivery or treatmentconfigurations.

171. The system of example 161, wherein the at least one actuation rodcomprises a first actuation rod and a second actuation rod.

172. The system of example 171, wherein the first actuation rodcomprises a distal portion coupled to the lysing tip, wherein the distalportion extends at least substantially parallel to the lysing tip axis.

173. The system of example 172, wherein the distal portion extends atleast substantially perpendicular to a proximal portion of the firstactuation rod.

174. The system of example 173, wherein the at least one lysing membercomprises a lysing plate, and wherein the distal portion is coupleddirectly to the lysing plate.

175. The system of example 174, wherein the distal portion is pivotablycoupled to the lysing plate.

176. The system of example 175, further comprising a pivot member forcoupling the lysing plate to the first actuation rod.

177. The system of example 161, further comprising a horizontal tunnelextending through each of the plurality of beads, wherein the at leastone lysing member is positioned to extend at least partially through thehorizontal tunnel.

178. The system of example 177, wherein the at least one lysing membercomprises a lysing plate, and wherein the lysing plate extends throughthe horizontal tunnel to define a plurality of lysing segments betweeneach pair of adjacent beads.

179. The system of example 177, wherein each of the plurality of beadscomprises a vertical tunnel extending between an upper end of the beadand a lower end of the bead.

180. The system of example 179, further comprising a plurality of pins,wherein each of the plurality of pins extends through one of thevertical tunnels, and wherein each of the plurality of pins also extendsthrough an opening formed in the lysing plate to secure the plurality ofbeads to the lysing plate.

181. The system of example 161, wherein the at least one actuation rodcomprises a hinge structure.

182. The system of example 179, wherein the hinge structure isconfigured to allow the lysing tip to be rotated at least one of aboveand below a cross-sectional profile of an opening at the distal end ofthe cannula in the treatment configuration.

183. The system of example 182, wherein the at least one actuation rodcomprises a first actuation rod and a second actuation rod, wherein thefirst actuation rod comprises a first hinge structure, and wherein thesecond actuation rod comprises a second hinge structure.

184. The system of example 183, wherein both the first and second hingestructures are configured to allow the lysing tip to be rotated eitherabove or below the cross-sectional profile of the opening at the distalend of the cannula in the treatment configuration.

185. The system of example 161, further comprising a second cannula,wherein the second cannula comprises a lumen having a smallercross-sectional size than the cannula, wherein the second cannula isconfigured to be received within the cannula, and wherein the lysing tipis configured such that the plurality of beads is configured to be fullyreceived within the cannula and the second cannula in the deliveryconfiguration.

186. The system of example 161, wherein the lysing tip further comprisesa support member coupled to the at least one lysing member and extendingalong the orientational-deployment side of the lysing tip, wherein thesupport member is configured to facilitate coupling of the lysing tipwith the at least one actuation rod.

187. The system of example 186, wherein the support member is coupled tothe at least one lysing member adjacent to the two outer beads.

188. The system of example 187, wherein the support member is coupled tothe at least one lysing member adjacent to respective inner surfaces ofthe two outer beads.

189. The system of example 186, wherein the support member is formed ina bow shape from a first end of the support member coupled with the atleast one lysing member to a second end of the support member coupledwith the at least one lysing member opposite from the first end.

190. The system of example 189, wherein the at least one actuation rodcomprises a first actuation rod and a second actuation rod, wherein thesupport member comprises a first hole configured to receive a firstcoupling member for coupling the first actuation rod to the supportmember, and wherein the support member further comprises a second holeconfigured to receive a second coupling member for coupling the secondactuation rod to the support member.

191. The system of example 190, wherein the first coupling membercomprises a pin, and wherein the second coupling member comprises a pin.

192. The system of example 190, wherein the first hole is offset fromthe second hole with respect to at least one central axis of the lysingtip.

193. The system of example 192, wherein the first hole is offset fromthe second hole with respect to at least one of a central axis definedby the at least one lysing member and a central axis of the lysing tipextending between the treatment side and the orientational-deploymentside of the lysing tip.

194. The system of example 193, wherein the first hole is positioned afirst distance from the at least one lysing member, wherein the secondhole is positioned a second distance from the at least one lysingmember, and wherein the first distance differs from the second distance.

195. The system of example 186, wherein the at least one actuation rodcomprises a first actuation rod and a second actuation rod, wherein thesupport member comprises a first hole configured to receive a first pinfor coupling the first actuation rod to the support member, and whereinthe support member further comprises a second hole configured to receivea second pin for coupling the second actuation rod to the supportmember.

196. The system of example 195, wherein the support member is formedwith a first knob protruding from the support member, and wherein thefirst hole is formed in the first knob.

197. The system of example 196, wherein the support member is formedwith a second knob protruding from the support member, and wherein thesecond hole is formed in the second knob.

198. The system of example 197, wherein the support member is formed ina bow shape from a first end of the support member coupled with the atleast one lysing member to a second end of the support member coupledwith the at least one lysing member opposite from the first end.

199. The system of example 161, wherein the at least one actuation rodcomprises a lysing tip receptacle configured to at least partiallyreceive the lysing tip when the lysing tip is repositioned from thetreatment configuration to the delivery configuration.

200. The system of example 199, wherein the lysing tip further comprisesa support member coupled to the at least one lysing member and extendingalong the orientational-deployment side of the lysing tip, wherein thesupport member is configured to facilitate coupling of the lysing tipwith the at least one actuation rod, and wherein the lysing tipreceptacle is configured to receive the support member.

201. The system of example 199, wherein the at least one actuation rodcomprises a first actuation rod and a second actuation rod, and whereinthe lysing tip receptacle comprises a cutout region formed in the firstactuation rod.

202. The system of example 161, wherein the at least one actuation rodcomprises a first actuation rod and a second actuation rod, wherein thefirst actuation rod comprises a distal portion and a proximal portion,wherein the second actuation rod comprises a distal portion and aproximal portion, and wherein the distal portions of the first andsecond actuation rods are configured to pivot with respect to theproximal portions of the first and second actuation rods.

203. The system of example 202, wherein the first actuation rodcomprises a first hinge member configured to pivot the proximal portionof the first actuation rod with respect to the distal portion of thefirst actuation rod, wherein the second actuation rod comprises anopening configured to at least partially receive the first hinge memberwhile the lysing tip is in the delivery configuration.

204. The system of example 203, wherein the first actuation rod furthercomprises a lysing tip receptacle configured to at least partiallyreceive the lysing tip when the lysing tip is repositioned from thetreatment configuration to the delivery configuration.

205. The system of example 161, wherein the lysing tip and the cannulaare configured such that the lysing tip may be fully received within thecannula in the delivery configuration.

206. The system of example 205, wherein the electrosurgical system isconfigured such that the lysing tip axis extends at an angle withrespect to the axis of the lumen of the cannula in the deliveryconfiguration.

207. The system of example 161, wherein the at least one lysing membercomprises a single lysing member, wherein the single lysing memberdefines a plurality of lysing segments, and wherein each lysing segmentextends between an adjacent pair of beads of the plurality of beads.

208. The system of example 207, further comprising a plurality ofspacers, wherein each spacer of the plurality of spacers is coupled witha lysing segment of the plurality of lysing segments.

209. The system of example 208, wherein each of the plurality of spacersis configured to confine each of the plurality of beads to apredetermined region relative to the single lysing member.

210. The system of example 207, further comprising a plurality ofprotuberances coupled with the single lysing member, wherein each of theplurality of lysing segments comprises a first protuberance at a firstend of the lysing segment and a second protuberance at a second end ofthe lysing segment.

211. The system of example 207, wherein the single lysing membercomprises a non-circular shape in cross section along at least a portionof the single lysing member.

212. The system of example 211, wherein the single lysing membercomprises a non-circular shape in cross section only at locationscorresponding with each of the plurality of beads.

213. The system of example 211, wherein the single lysing membercomprises a non-circular shape in cross section along an entire lengthof the single lysing member.

214. The system of example 161, wherein each of the plurality of beadshas an at least substantially identical length extending between thetreatment side and the orientational-deployment side.

215. The system of example 161, wherein the at least one actuation rodcomprises a first actuation rod and a second actuation rod, wherein atleast one of the first actuation rod and the second actuation rodcomprises a retraction guide configured to facilitate repositioning ofthe lysing tip between the treatment configuration and the deliveryconfiguration.

216. The system of example 215, wherein the retraction guide isconfigured to provide a restorative force to the lysing tip bycontacting the cannula when the lysing tip is repositioned from thetreatment configuration to the delivery configuration.

217. The system of example 216, wherein the retraction guide comprises aspring positioned on the first actuation rod.

218. The system of example 216, wherein the retraction guide extendsfrom the first actuation rod by a first distance, wherein at least onebead of the plurality of beads extends from the first actuation rod inthe delivery configuration by a second distance, and wherein the firstdistance is at least one of approximately equal to and slightly greaterthan the second distance.

219. The system of example 218, wherein the first distance is betweenabout 1% and about 10% greater than the second distance.

220. The system of example 161, further comprising a protective sleeveconfigured to encase the lysing tip during delivery.

221. The system of example 220, wherein the protective sleeve isremovable such that the protective sleeve may be removed prior totreatment using the lysing tip.

222. The system of example 220, wherein the protective sleeve is made upof a biodegradable material.

223. The system of example 161, wherein the lysing tip further comprisesan antenna configured to track a location of the lysing tip during asurgical procedure.

224. The system of example 223, wherein the antenna comprises aradiofrequency identification tag.

225. The system of example 223, wherein the lysing tip further comprisesa sensor, and wherein the sensor is coupled with the antenna such thatlocation data may be combined with sensor data from the sensor.

226. The system of example 225, wherein the sensor comprises atemperature sensor.

227. The system of example 161, further comprising a canal configured toselectively deliver fluids adjacent to the lysing tip during a surgicalprocedure.

228. The system of example 227, wherein the canal is selectivelyretractable and advanceable relative to the cannula.

229. The system of example 161, wherein the at least one lysing membercomprises a first lysing member and a second lysing member, and whereinthe first lysing member is electrically isolated from the second lysingmember.

230. The system of example 229, wherein the lysing tip is configured todeliver bipolar electrosurgical energy, wherein the first lysing membercomprises a positive lysing member configured to deliver positiveelectrosurgical energy, and wherein the second lysing member comprises anegative lysing member configured to deliver negative electrosurgicalenergy.

231. The system of example 229, wherein the first lysing member definesonly a first lysing segment of the plurality of lysing segments, andwherein the second lysing member defines only a second lysing segment ofthe plurality of lysing segments.

232. The system of example 229, further comprising:

-   -   a first tunnel formed in at least a first subset of the        plurality of beads; and    -   a second tunnel formed in at least a second subset of the        plurality of beads, wherein the first lysing member extends        through the first tunnel, and wherein the second lysing member        extends through the second tunnel.

233. The system of example 232, wherein the first lysing membercomprises a flexible wire and wherein the second lysing member comprisesa flexible wire.

234. The system of example 233, further comprising means for maintaininga flexible lysing member in a rigid state to define a lysing segment.

235. The system of example 234, wherein the means for maintaining aflexible lysing member in a rigid state to define a lysing segmentcomprises at least one of a bead tunnel having a cross-sectionaldimension less than a cross-sectional dimension of a lysing memberextending therethrough and a plurality of protuberances.

236. An electrosurgical system, comprising:

-   -   a lysing tip comprising a treatment side and an        orientational-deployment side opposite from the treatment side,        wherein the lysing tip comprises an upper side and a lower side        opposite from the upper side, and wherein the lysing tip further        comprises:        -   a plurality of beads;        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads,            wherein the lysing tip comprises a primary axis extending            between a first outer bead of the plurality of beads and a            second outer bead of the plurality of beads, and wherein            each of the plurality of beads comprises a tip extending at            least substantially perpendicular to the primary axis; and        -   an energy window positioned on at least one of the upper            side and the lower side of the lysing tip, wherein the            energy window is configured to selectively deliver energy            therethrough to treat tissue during a surgical procedure            with the lysing tip; and    -   a cannula configured for delivery of the lysing tip therethrough        into a patient's body, wherein the cannula comprises a cannula        axis, and wherein the system is configured such that the lysing        tip can be delivered through the cannula in a delivery        configuration.

237. The system of example 229, wherein the system is configured suchthat the lysing tip can be delivered through the cannula in a deliveryconfiguration with the primary axis aligned with the cannula axis.

238. The system of example 229, wherein the energy window comprises anenergy window array defined by plurality of electrode termini.

239. The system of example 238, wherein each of the plurality ofelectrode termini are separated from one another such that the energywindow is configured to treat tissue with the energy window to result indamaged tissue from the electrode termini and intermittent islands ofundamaged tissue.

240. The system of example 229, further comprising a support memberextending between the first outer bead of the plurality of beads and thesecond outer bead of the plurality of beads opposite from the firstouter bead on the orientational-deployment side.

241. The system of example 240, further comprising a first actuation rodand a second actuation rod, wherein the first and second actuation rodsare configured to reorient the lysing tip between a deliveryconfiguration in which the primary axis extends through the lumen and atreatment configuration in which the primary axis extends at leastsubstantially perpendicular to an axis of the lumen outside of a distalend of the cannula.

242. The system of example 241, wherein the first actuation rod iscoupled to the support member adjacent to the first outer bead, andwherein the second actuation rod is coupled to the support memberadjacent to the second outer bead.

243. The system of example 242, wherein the support member is formed ina bow shape from a first end of the support member to a second end ofthe support member opposite from the first end.

244. The system of example 243, wherein the support member is coupledwith the at least one lysing member at the first end second end of thesupport member and at the second end of the support member.

245. The system of example 229, wherein the energy window comprises anenergy window strip, and wherein the energy window strip is positionedto extend along respective upper surfaces of each of the plurality ofbeads.

246. The system of example 240, wherein the energy window stripcomprises a plurality of electrode termini.

247. The system of example 246, wherein each of the plurality ofelectrode termini protrude from an upper surface of the energy windowstrip.

248. The system of example 240, further comprising an energy windowcover configured to receive the energy window strip and couple theenergy window strip with each of the plurality of beads.

249. The system of example 248, wherein the energy window covercomprises an insulation cover made up of a non-conductive material, andwherein the energy window strip is made up of a conductive materialconfigured to receive and delivery energy therethrough.

250. The system of example 249, wherein the insulation cover comprises:

-   -   an elongated base configured to receive the energy window strip;        and    -   a plurality of bead coupling members, wherein each of the        plurality of bead coupling members is configured to couple with        one of the plurality of beads.

251. The system of example 240, wherein the energy window strip isconfigured to deliver at least one of LASER, intense pulse light,resistive heating, radiant heat, ultrasound, and microwave energy.

252. The system of example 240, wherein the energy window strip isconfigured to deliver radiofrequency energy.

253. The system of example 238, wherein the energy window is configuredto deliver bipolar electrosurgical energy, and wherein a first subset ofthe plurality of electrode termini are electrically isolated from asecond subset of the plurality of electrode termini.

254. A method for delivery of an electrosurgical device into a patientfor use during a surgical procedure, the method comprising the steps of:

-   -   delivering a lysing tip through a first cannula subcutaneously        into a patient's body, wherein the lysing tip comprises:        -   a plurality of beads;        -   at least one lysing member defining at least one lysing            segment extending between each pair of adjacent beads; and        -   a support member coupled with the at least one lysing            member, wherein the support member is configured to            facilitate coupling of the lysing tip to a surgical tool            used to control the lysing tip during a surgical procedure            within the patient's body;    -   advancing the lysing tip beyond a distal opening of the first        cannula;    -   delivering the surgical tool into the patient's body adjacent to        the lysing tip;    -   coupling the lysing tip with the surgical tool; and    -   delivering electrosurgical energy from the surgical tool to the        at least one lysing member.

255. The method of example 254, wherein the support member extendsbetween a first outer bead of the plurality of beads and a second outerbead of the plurality of beads opposite from the first outer bead on theorientational-deployment side.

256. The method of example 254, wherein the at least a proximal portionof the support member extends along the orientational-deployment side ofthe lysing tip, and wherein the step of coupling the lysing tip to thesurgical tool comprises coupling the proximal portion of the supportmember with the surgical tool.

257. The method of example 256, wherein the support member defines a bowshape, wherein the support member comprises a grasping pad, wherein thesurgical tool comprises at least one jaw, and wherein the step ofcoupling the lysing tip to the surgical tool comprises coupling thegrasping pad with the at least one jaw.

258. The method of example 254, further comprising a tunnel extending atleast partially through each of the plurality of beads, wherein the atleast one lysing member is positioned to extend at least partiallythrough the tunnel to define the at least one lysing segment betweeneach pair of adjacent beads.

259. The method of example 254, wherein the step of delivering thesurgical tool into the patient's body adjacent to the lysing tipcomprises delivering the surgical tool through a second cannula.

260. The method of example 254, further comprising:

-   -   advancing a second surgical tool into the patient's body;    -   using the second surgical tool to couple the lysing tip with the        first surgical tool;    -   releasing the lysing tip from the second surgical tool; and    -   using the first surgical tool to perform a surgical procedure        with the lysing tip.

261. The method of example 254, wherein the lysing tip further comprisesa plurality of spacers, and wherein each of the plurality of spacers iscoupled with a respective lysing segment of the plurality of lysingsegments.

262. A lysing tip, comprising:

-   -   a treatment side and an orientational-deployment side opposite        from the treatment side;    -   a grasping pad on the orientational-deployment side, wherein the        grasping pad is configured to receive and deliver        electrosurgical energy;    -   a plurality of beads;    -   a lysing rod defining a plurality of lysing segments, wherein        each of the plurality of lysing segments extends between a pair        of adjacent beads of the plurality of beads; and    -   a support member coupled to the lysing rod at opposite ends of        the lysing rod, wherein the support member is configured to        facilitate coupling of the lysing tip to a surgical tool used to        control the lysing tip during a surgical procedure within a        patient's body and deliver electrosurgical energy through the        grasping pad and into the lysing rod.

263. The lysing tip of example 262, wherein the grasping pad is formedon the support member.

264. The lysing tip of example 263, wherein the grasping pad comprises atab projecting from the support member.

265. The lysing tip of example 262, wherein the support member iscoupled to the lysing rod between a first outer bead of the plurality ofbeads and a second outer bead of the plurality of beads opposite fromthe first outer bead on the orientational-deployment side.

266. The lysing tip of example 265, wherein the support member is formedin a bow shape from a first end of the support member coupled with thelysing rod to a second end of the support member coupled with the lysingrod opposite from the first end.

267. The lysing tip of example 262, further comprising a plurality ofspacers, wherein each of the plurality of spacers is coupled with thelysing rod at a respective lysing segment of the plurality of lysingsegments.

268. The lysing tip of example 267, wherein each of the plurality ofspacers is fixedly coupled with the lysing rod.

269. The lysing tip of example 267, wherein each of the plurality ofspacers comprises a slot configured to allow each of the respectivespacers to be coupled with the lysing rod by advancing each of therespective spacers towards the lysing rod adjacent to the slot in adirection perpendicular to an axis of the lysing rod.

270. The lysing tip of example 267, wherein each of the plurality ofspacers comprises a conductive material such that electrosurgical energycan be delivered through the spacers from the lysing rod.

271. The lysing tip of example 267, wherein each of the plurality ofspacers is configured to confine at least one respective bead of theplurality of beads to a predetermined location on the lysing rod.

272. The lysing tip of example 271, wherein each of the plurality ofspacers is configured to restrict an amount of rotation of at least onerespective bead of the plurality of beads on the lysing rod.

273. The lysing tip of example 272, wherein each of the plurality ofspacers comprises opposing beveled edges configured to selectivelyrestrict rotation of adjacent beads on the lysing rod.

274. The lysing tip of example 271, wherein each of the plurality ofspacers is in direct contact with two respective beads on opposite endsof the spacer.

275. The lysing tip of example 262, further comprising a plurality ofprotuberances configured to confine each of the plurality of beads to apredetermined region relative to the lysing rod, wherein each of thelysing segments comprises a first protuberance adjacent a firstrespective bead and a second protuberance adjacent a second respectivebeads.

276. The lysing tip of example 273, wherein the plurality ofprotuberances are configured to prevent any lateral movement of theplurality of beads on the lysing rod.

277. The lysing tip of example 262, wherein the lysing rod comprises ahollow rod.

278. The lysing tip of example 277, wherein the lysing rod comprises afirst plurality of sections having non-circular cross-sections.

279. The lysing tip of example 278, wherein each of the first pluralityof sections correspond with each of the plurality of lysing segments.

280. The lysing tip of example 278, wherein each of the plurality ofsections is configured to confine each of the plurality of beads to apredetermined region relative to the lysing rod.

281. The lysing tip of example 278, wherein each of the plurality ofsections comprises a flattened shape.

282. The lysing tip of example 281, wherein each of the plurality ofsections comprises a leading edge extending towards the treatment side.

283. The lysing tip of example 278, wherein the lysing rod furthercomprises a second plurality of sections having circular cross-sections.

284. The lysing tip of example 283, wherein the second plurality ofsections extend through tunnels extending at least partially througheach of the plurality of beads.

285. The lysing tip of example 262, wherein the lysing rod extends atleast partially through each of the plurality of beads.

286. The lysing tip of example 285, wherein the lysing rod defines acoupling axis with the plurality of beads, wherein each of the pluralityof beads defines a bead axis extending from a leading end to a trailingend, and wherein the bead axis of each of the plurality of beads is atleast substantially perpendicular to the coupling axis.

287. The lysing tip of example 286, wherein the lysing rod extendsthrough at least a subset of the plurality of beads at a non-centrallocation relative to a bead axis of each of the at least a subset of theplurality of beads.

288. The lysing tip of example 287, wherein the lysing rod extendsthrough each of the plurality of beads at a non-central locationrelative to a bead axis of each of the plurality of beads.

289. The lysing tip of example 287, wherein the non-central location ispositioned towards the leading end of each of the at least a subset ofthe plurality of beads.

290. The lysing tip of example 262, wherein each of the plurality ofbeads defines a bead axis extending from a leading end to a trailingend, wherein the plurality of beads comprises a first subset of beadshaving a first length extending along the bead axis of each of the firstsubset of beads, wherein the plurality of beads comprises a secondsubset of beads having a second length extending along the bead axis ofeach of the second subset of beads, and wherein the first length isgreater than the second length.

291. The lysing tip of example 290, wherein the first subset of beadscomprises a first outer bead positioned adjacent to a first end of thelysing rod and a second outer bead positioned adjacent to a second endof the lysing rod opposite from the first end.

292. The lysing tip of example 291, wherein each of the second subset ofbeads comprises a flattened trailing end, and wherein the flattenedtrailing end is positioned adjacent to the support member so as toaccommodate the support member extending proximally of the trailing endsof each of the second subset of beads.

293. The lysing tip of example 292, wherein the support member comprisesan insulated portion and a conductive portion.

294. The lysing tip of example 293, wherein the conductive portioncomprises at least a portion of a grasping pad formed on the supportmember.

295. The lysing tip of example 294, wherein the conductive portioncomprises an opening formed on the grasping pad.

296. The lysing tip of example 262, wherein each of at least a subset ofthe plurality of beads is configured so as to allow for rotation of eachrespective bead of the at least a subset of the plurality of beads aboutthe lysing rod.

297. The lysing tip of example 296, wherein each of the plurality ofbeads is configured so as to allow for rotation of each respective beadof the plurality of beads about the lysing rod.

298. The lysing tip of example 262, wherein each of at least a subset ofthe plurality of beads comprises a trailing end having a rougherexterior surface that its respective leading end.

299. The lysing tip of example 298, wherein the at least a subset of theplurality of beads comprises a first outer bead positioned at a firstend of the lysing rod and a second outer bead positioned at a second endof the lysing rod opposite from the first end.

300. The lysing tip of example 299, wherein the first outer bead ispositioned adjacent to a first end of the lysing rod, and wherein thesecond outer bead is positioned adjacent to a second end of the lysingrod opposite from the first end of the lysing rod.

301. The lysing tip of example 262, wherein each of at least a subset ofthe plurality of beads comprises a plurality of faceted surfaces.

302. The lysing tip of example 301, wherein each of at least a subset ofthe plurality of faceted surfaces is positioned at an acute angle withrespect to one another.

303. The lysing tip of example 302, each of at least a subset of theplurality of beads comprises a first faceted surface on an upper side ofthe bead and a second faceted surface on a lower side of the bead,wherein the first faceted surface and the second faceted surface defineda wedge shape at a leading end of the bead.

304. The lysing tip of example 262, wherein each of at least a subset ofthe plurality of beads is configured to move with respect to the lysingrod during a surgical procedure.

305. The lysing tip of example 304, wherein each of the at least asubset of the plurality of beads is configured to pivot on the lysingrod.

306. The lysing tip of example 305, wherein each of the at least asubset of the plurality of beads is configured to pivot on the lysingrod in at least two separate planes.

307. The lysing tip of example 262, wherein at least one of theplurality of beads comprises a hole separated from the lysing rod, andwherein the hole is configured to be coupled with means for maintainingretrievability of a free-floating lysing tip when the lysing tip isdecoupled from a grasping/control instrument.

308. The lysing tip of example 262, wherein the means for maintainingretrievability of a free-floating lysing tip when the lysing tip isdecoupled from a grasping/control instrument comprises a cord.

309. The lysing tip of example 262, further comprising:

-   -   a first coupling tip at a first end of the lysing rod; and    -   a second coupling tip at a second end of the lysing rod, wherein        the first coupling tip and the second coupling tip are        configured to secure the lysing rod to two outermost beads of        the plurality of beads.

310. The lysing tip of example 309, wherein the first coupling tipdiffers from the second coupling tip.

311. The lysing tip of example 309, wherein the first coupling tipcomprises a weld defining a cross-sectional dimension greater in atleast one direction that a cross-sectional dimension of the lysing rod.

312. The lysing tip of example 262, wherein the lysing rod comprises atleast one of a non-conductive coating and a non-conductive coverpositioned at opposing ends of the lysing rod.

313. The lysing tip of example 312, further comprising:

-   -   a first coupling tip at a first end of the lysing rod; and    -   a second coupling tip at a second end of the lysing rod, wherein        the first coupling tip and the second coupling tip are        configured to secure the lysing rod to two outermost beads of        the plurality of beads, and wherein the first coupling tip and        the second coupling tip both comprise at least one of a        non-conductive coating and a non-conductive cover.

314. The lysing tip of example 262, further comprising:

-   -   a first coupling tip at a first end of the lysing rod; and    -   a second coupling tip at a second end of the lysing rod, wherein        the first coupling tip and the second coupling tip are        configured to secure the lysing rod to two outermost beads of        the plurality of beads, wherein the first coupling tip is        positioned within a first outermost bead of the plurality of        beads, and wherein the second coupling tip is positioned within        a second outermost bead of the plurality of beads opposite from        the first outermost bead.

315. The lysing tip of example 314, wherein each of the first outermostbead and the second outermost bead comprises two concentric tunnels, andwherein each of the first coupling tip and the second coupling tip ispositioned and configured to engage a ledge positioned at a transitionpoint between the two concentric tunnels.

316. The lysing tip of example 314, wherein each of the first outermostbead and the second outermost bead comprises a tunnel that tapers from alarger dimension to a smaller dimension at an inner side of theoutermost beads, and wherein each of the first coupling tip and thesecond coupling tip is configured to engage a portion of theirrespective tunnel between the larger dimension and the smallerdimension.

317. The lysing tip of example 262, wherein the grasping pad comprises aplate having opposing flattened surfaces configured to engage opposingjaws of the surgical tool.

318. The lysing tip of example 262, further comprising a non-conductivesheath configured to cover at least a portion of the lysing tip, whereinthe non-conductive sheath is configured to expose the plurality oflysing segments.

319. An electrosurgical system, comprising:

-   -   a lysing tip comprising:        -   a plurality of beads; and        -   a lysing member coupling the plurality of beads together,            wherein the lysing member defines at least one lysing            segment extending between each pair of adjacent beads of the            plurality of beads; and    -   a surgical tool configured to selectively engage the lysing tip        and control the lysing tip during a surgical procedure, wherein        the surgical tool comprises a pair of jaws configured to engage        the lysing tip by grasping the lysing tip.

320. The electrosurgical system of example 319, wherein theelectrosurgical system is configured such that the surgical tool isconfigured to selectively engage the lysing tip by grasping the lysingmember.

321. The electrosurgical system of example 319, wherein a distal end ofthe surgical tool is configured to protrude distally beyond the lysingmember when the lysing tip is engaged with the pair of jaws.

322. The electrosurgical system of example 320, wherein, when the lysingtip is engaged with the pair of jaws, the plurality of beads and thedistal end of the surgical tool are configured to facilitate bluntdissection of tissue during a surgical procedure.

323. The electrosurgical system of example 320, wherein the distal endof the surgical tool is configured to protrude distally beyond thelysing member when the lysing tip is engaged with the pair of jaws by adistance at least substantially equal to a distance with which each ofthe plurality of beads protrudes distally from the lysing member.

324. The electrosurgical system of example 320, wherein a portion of thedistal end of the surgical tool that protrudes distally beyond thelysing member when the lysing tip is engaged with the pair of jaws has ashape that is at least substantially identical to a shape of a portionof each of the plurality of beads that protrudes distally beyond thelysing member.

325. The electrosurgical system of example 319, wherein the lysingmember comprises a lysing plate.

326. The electrosurgical system of example 319, further comprising aslot defined by at least one of the pair of jaws, wherein the slot isconfigured to receive the lysing member.

327. The electrosurgical system of example 326, wherein the lysingmember comprises a lysing plate, and wherein the slot has a size whenthe pair of jaws is closed that is at least substantially identical to asize of the lysing plate that is configured to be received in the slotsuch that the lysing plate can be rigidly received within the slot.

328. The electrosurgical system of example 319, wherein the surgicaltool is configured to deliver electrosurgical energy to the lysingmember through the pair of jaws when the lysing tip is coupled with thesurgical tool.

329. The electrosurgical system of example 319, wherein the lysingmember comprises a lysing rod.

330. The electrosurgical system of example 329, wherein the lysing rodis configured to be received in a slot formed within at least one jaw ofthe pair of jaws.

331. The electrosurgical system of example 330, wherein an upper jaw ofthe pair of jaws comprises an overhang portion that protrudes distallyof a lower jaw of the pair of jaws such that a distal end of thesurgical tool is wholly defined by the upper jaw.

332. The electrosurgical system of example 330, wherein the lysing rodis configured to be loosely received in the slot such that the lysingtip is allowed to rotate with respect to the surgical tool.

333. The electrosurgical system of example 329, wherein the lysing tipis configured to be coupled with the surgical tool such that, whilecoupled with the lysing tip, a distal end of the surgical toolprotruding distally beyond the lysing rod, has a shape that at leastsubstantially mimics the shapes of each of the plurality of beads.

334. The electrosurgical system of example 329, wherein each of theplurality of beads comprises a hole extending to the lysing rod.

335. The electrosurgical system of example 334, wherein each of theholes of each of the plurality of beads comprises a substantiallyvertical tunnel extending from an upper surface of each of the pluralityof beads to the lysing rod.

336. The electrosurgical system of example 334, wherein each of theholes of each of the plurality of beads comprises a binding materialdirectly coupling each of the plurality of beads to the lysing rod.

337. The electrosurgical system of example 329, further comprising agrasping plate coupled with the lysing rod, wherein the surgical tool isconfigured to selectively engage the lysing tip and control the lysingtip during a surgical procedure by grasping the grasping plate.

338. The electrosurgical system of example 337, wherein the surgicaltool comprises an upper jaw and a lower jaw defining a receiving slot,wherein the lysing plate comprises an upper surface and a lower surface,and wherein the grasping plate is configured to be received in thereceiving slot such that the upper surface engages a first inner surfaceof the upper jaw and such that the lower surface engages a second innersurface of the lower jaw.

339. The electrosurgical system of example 337, wherein the lysing rodis coupled to the grasping plate such that the lysing rod fits within agroove formed in a distal surface of the grasping plate.

340. The electrosurgical system of example 339, wherein the lysing rodis coupled to the grasping plate by way of a snap-fit engagement betweena central portion of the lysing rod and the groove.

341. The electrosurgical system of example 337, wherein each of theplurality of beads comprises a trailing end and a leading end, whereinthe trailing end of each of the plurality of beads comprises a roughersurface than the leading end.

342. The electrosurgical system of example 337, wherein each of theplurality of beads is at least partially rotatable with respect to thelysing rod.

343. The electrosurgical system of example 342, wherein each of theplurality of beads is at least partially rotatable with respect to eachother bead of the plurality of beads.

344. The electrosurgical system of example 337, wherein a first outerend of the lysing rod terminates within a first outer bead of theplurality of beads, and wherein a second outer end of the lysing rodterminates within a second outer bead of the plurality of beads.

345. The electrosurgical system of example 344, wherein the lysing rodcomprises opposing coupling tips positioned on the first outer end andthe second outer end.

346. The electrosurgical system of example 345, wherein each of thefirst outer bead and the second outer bead comprises an inner tunnel andan outer tunnel, and wherein the outer tunnel comprises a largercross-sectional dimension than the inner tunnel such that each of thecoupling tips is able to fit within the outer tunnel but unable to fitwithin the inner tunnel.

347. The electrosurgical system of example 337, wherein the graspingplate comprises at least one of a conductive opening and a conductiveprojection, wherein the surgical tool comprises at least one of aconductive opening and a conductive projection, and wherein theconductive opening or projection of the grasping plate is configured toselectively engage the conductive projection or opening of the surgicaltool to allow for delivery of electrosurgical energy from the surgicaltool, through the grasping plate, and into the lysing rod.

348. The electrosurgical system of example 347, wherein the graspingplate comprises a conductive opening, wherein the surgical toolcomprises a pair of jaws comprising a conductive projection extendingfrom one of the jaws of the pair of jaws, and wherein the grasping plateis insulated other than the conductive opening.

349. The electrosurgical system of example 348, wherein the graspingplate comprises a plurality of conductive openings, wherein the surgicaltool comprises a plurality of conductive projections extending from oneof the jaws, and wherein each of the plurality of conductive projectionsis configured to be received in a respective conductive opening of theplurality of conductive openings.

350. The electrosurgical system of example 319, wherein the plurality ofbeads comprises a first outer bead positioned at a first end of thelysing member and a second outer bead positioned at a second end of thelysing member opposite from the first end.

351. The electrosurgical system of example 350, wherein the first outerbead comprises a first rounded outer proximal corner, and wherein thesecond outer bead comprises a second rounded outer proximal cornerpositioned opposite from the first rounded outer proximal corner.

352. The electrosurgical system of example 351, wherein each of thefirst outer bead and the second outer bead comprises a flattenedproximal surface.

353. The electrosurgical system of example 352, where each of theflattened proximal surfaces extends into a rounded o

354. The electrosurgical system of example 350, wherein each of thefirst outer bead and the second outer bead comprises an ellipsoidalshape extending from a proximal tip to a distal tip of each of the firstouter bead and the second outer bead.

355. The electrosurgical system of example 354, wherein each of thefirst outer bead and the second outer bead comprises a hole, wherein thehole is configured to couple with a safety line that is configured toextend from the lysing tip within a patient's body to a location outsideof the patient's body during a surgical procedure.

356. The electrosurgical system of example 355, wherein the safety linecomprises at least one of a cord, a suture, and a hook.

357. The electrosurgical system of example 355, wherein the holecomprises a thru-hole, and wherein the hole is positioned in a proximalportion of each of the first outer bead and the second outer beadproximally of the lysing member.

358. The electrosurgical system of example 357, wherein the safety linecomprises a loopable element configured to extend through the hole.

359. An electrosurgical system, comprising:

-   -   a lysing tip comprising:        -   a plurality of beads; and        -   a lysing member coupling the plurality of beads together,            wherein the lysing member defines at least one lysing            segment extending between each pair of adjacent beads of the            plurality of beads; and    -   a surgical tool configured to selectively engage the lysing tip        and deliver electrosurgical energy to the lysing member during a        surgical procedure.

360. The electrosurgical system of example 359, wherein the lysing tipfurther comprises a shaft extending proximally from the lysing tip,wherein the shaft is electrically coupled with the lysing member, andwherein the surgical tool comprises a conductive slot configured toengage the shaft such that, when the shaft is engaged with theconductive slot, the surgical tool is able to deliver electrosurgicalenergy to the lysing member through the shaft.

361. The electrosurgical system of example 360, wherein the lysing tipfurther comprises a support member coupled with the lysing member.

362. The electrosurgical system of example 361, wherein the shaft iscoupled with the support member.

363. The electrosurgical system of example 362, wherein the shaftcomprises a conductive inner core, and wherein at least a portion of theshaft comprises an insulating outer shell.

364. The electrosurgical system of example 361, wherein the supportmember defines a bow shape, wherein the support member comprises a firstend positioned adjacent to a first outer bead of the plurality of beadsand coupled to the lysing member, and wherein the support membercomprises a second end positioned adjacent to a second outer bead of theplurality of beads opposite from the first outer bead and coupled to thelysing member.

365. The electrosurgical system of example 359, further comprising atether extending from the lysing tip.

366. The electrosurgical system of example 365, wherein the surgicaltool comprises an opening configured to receive the tether so as tofacilitate coupling the lysing tip to the surgical tool.

367. The electrosurgical system of example 366, wherein the surgicaltool comprises at least one jaw configured to receive a portion of thelysing tip.

368. The electrosurgical system of example 367, wherein the opening ispositioned in the at least one jaw.

369. The electrosurgical system of example 368, wherein the lysing tipfurther comprises a grasping pad configured to be received in the atleast one jaw, wherein the tether extends from the grasping pad, andwherein the tether is configured to allow the grasping pad to be pulledinto the at least one jaw by pulling the tether proximally.

370. The electrosurgical system of example 359, further comprising atleast one magnet configured to guide the lysing tip to a coupling regionof the surgical tool.

371. The electrosurgical system of example 370, wherein the couplingregion comprises a pair of jaws formed on a distal end of the surgicaltool.

372. The electrosurgical system of example 371, wherein the at least onemagnet is positioned on at least one jaw of the pair of jaws.

373. The electrosurgical system of example 371, wherein the lysing tipfurther comprises a grasping pad configured to be received in the pairof jaws to couple the lysing tip with the surgical tool, and wherein theat least one magnet comprises a first magnet positioned on the graspingpad and a second magnet positioned on at least one jaw of the pair ofjaws.

374. The electrosurgical system of example 359, wherein the surgicaltool comprises at least one of an opening and a projection, wherein thelysing tip comprises at least one of a projection and an openingconfigured to mate with the at least one of an opening and a projectionof the surgical tool to lock the lysing tip in place on the surgicaltool during a surgical procedure.

375. The electrosurgical system of example 374, wherein the surgicaltool comprises an upper jaw and a lower jaw, wherein the at least one ofan opening and a projection extends from at least one of the upper jawand the lower jaw, and wherein the lysing tip is configured to bereceived and engaged in between the upper jaw and the lower jaw during asurgical procedure.

376. The electrosurgical system of example 375, wherein the lysing tipcomprises a support member extending adjacent to and proximal of theplurality of beads, and wherein the at least one of a projection and anopening of the lysing tip is formed on the support member.

377. The electrosurgical system of example 376, wherein the lysing tipcomprises a first projection extending from an upper surface of thesupport member and a second projection extending from a lower surface ofthe support member, wherein the upper jaw comprises a first openingconfigured to receive the first projection, and wherein the lower jawcomprises a second opening configured to receive the second projection.

378. The electrosurgical system of example 377, wherein at least one ofthe first projection and the second projection is configured lock thelysing tip in place relative to the surgical tool at a preconfiguredrotational orientation.

379. The electrosurgical system of example 378, wherein the at least oneof the first projection and the second projection comprises a facetedsurface, and wherein the surgical tool comprises an opening comprising ashape configured to mate with the faceted surface.

380. The electrosurgical system of example 378, wherein the at least oneof the first projection and the second projection is configured to allowfor locking the lysing tip in place relative to the surgical tool at anyof a plurality of preconfigured rotational orientations.

381. The electrosurgical system of example 378, wherein the firstprojection is configured to lock the lysing tip in place relative to thesurgical tool at a preconfigured rotational orientation, and wherein thesecond projection is configured to be received in the second opening soas to allow the lysing tip to rotate with respect to the surgical toolwhile the lysing tip is coupled with the surgical tool.

382. The electrosurgical system of example 381, wherein the upper jaw isconfigured to move with respect to the lower jaw such that the lysingtip can be rotated while the second projection is received within thesecond opening and the first projection is withdrawn from the firstopening and then the upper jaw closed to insert the first projectioninto the first opening and lock the lysing tip at a particularrotational orientation.

383. A lysing tip, comprising:

-   -   a plurality of beads comprising a first outer bead and a second        outer bead opposite from the first outer bead; and    -   a lysing rod extending along a treatment side of the lysing tip        and extending at least partially through each of the plurality        of beads to couple the plurality of beads to one another,        wherein the lysing rod defines at least one lysing segment        extending between each pair of adjacent beads of the plurality        of beads, and wherein the lysing rod is configured such that a        central portion of the lysing rod protrudes further distally        from the treatment side than opposing portions of the lysing rod        immediately adjacent to the first outer bead and the second        outer bead.

384. The lysing tip of example 383, wherein the lysing rod extends in abowed shape along the treatment side of the lysing tip.

385. The lysing tip of example 384, wherein the plurality of beadsfurther comprises at least one middle bead positioned between the firstouter bead and the second outer bead, and wherein the at least onemiddle bead protrudes distally from the treatment side to a greaterextent than either the first outer bead or the second outer bead.

386. The lysing tip of example 384, further comprising a support memberextending along a side of the lysing tip opposite from the treatmentside, wherein the support member is configured to facilitate coupling ofthe lysing tip to a surgical tool used to control the lysing tip duringa surgical procedure within a patient's body.

387. The lysing tip of example 386, wherein the support member extendsin a bowed shape along the side of the lysing tip opposite from thetreatment side, and wherein the bowed shape of the support memberextends in an opposite direction relative to the bowed shape of thelysing rod.

388. The lysing tip of example 387, wherein the support member furthercomprises a tongue coupled with at least one central lysing segment ofthe lysing rod, wherein the tongue is configured to maintain the centralportion of the lysing rod in a position protruding further distally fromthe treatment side than opposing portions of the lysing rod.

389. The lysing tip of example 388, wherein the tongue is coupled with asingle lysing segment of the lysing rod.

390. The lysing tip of example 388, further comprising a groove formedin the tongue, wherein the at least one central lysing segment ispositioned within the groove.

391. The lysing tip of example 388, wherein the tongue is positioned incontact with two beads on opposing sides of the tongue such that thetongue defines a length of a center lysing segment of the plurality oflysing segments.

392. The lysing tip of example 391, further comprising a plurality ofspacers positioned on the lysing rod so as to confine each of theplurality of beads to predetermined locations on the lysing rod.

393. The lysing tip of example 392, wherein the center lysing segmentlacks a spacer, and wherein each of the lysing segments other than thecenter lysing segment comprises a spacer positioned thereon.

394. A lysing tip, comprising:

-   -   a plurality of beads;    -   at least one lysing rod defining at least one lysing segment        extending between each pair of adjacent beads;    -   a tunnel extending at least partially through each of the        plurality of beads, wherein the at least one lysing member is        positioned to extend at least partially through the tunnel to        define the at least one lysing segment between each pair of        adjacent beads; and    -   a plurality of sleeves positioned on the at least one lysing        rod, wherein each of the plurality of sleeves is positioned        within a bead of the plurality of beads in between the bead and        the at least one lysing rod.

395. The lysing tip of example 394, wherein the plurality of sleevescomprises:

-   -   a pair of outer bead sleeves positioned within two opposing        outer beads of the plurality of beads; and    -   at least one inner bead sleeve positioned within at least one        inner bead positioned between the two opposing outer beads,        wherein the pair of outer bead sleeves differs in structure from        the at least one inner bead sleeve.

396. The lysing tip of example 394, wherein each of the plurality ofsleeves comprises a material configured to at least partially insulateeach of the plurality of beads from heat from the at least one lysingrod.

397. The lysing tip of example 396, wherein each of the plurality ofsleeves comprises at least one of a ceramic material and ahigh-temperature thermoplastic.

398. The lysing tip of example 397, wherein each of the plurality ofsleeves comprises at least one of an alumina, a carbide, a nitride,quartz silica, a silicate, an yttria, a zirconia, a thermoset plastic,and a high-performance thermoplastic.

399. The lysing tip of example 394, wherein at least a subset of theplurality of sleeves is configured to rotate about the at least onelysing rod such that beads coupled with each of the at least a subset ofthe plurality of sleeves can rotate on its respective sleeve withrespect to the at least one lysing rod.

400. The lysing tip of example 399, wherein each of the plurality ofsleeves is configured to allow each of the plurality of beads to rotateabout the at least one lysing rod, and wherein each of the plurality ofbeads is configured to pivot with respect to the at least one lysing rodas it passes through tissue during a surgical procedure.

401. The lysing tip of example 394, wherein each of the plurality ofsleeves comprises a raised band, and wherein each of the raised bands isconfigured to prevent one of the beads from moving laterally along theat least one lysing rod.

402. The lysing tip of example 401, wherein the plurality of sleevescomprises:

-   -   a pair of outer bead sleeves positioned within two opposing        outer beads of the plurality of beads, wherein each of the pair        of outer bead sleeves comprises a raised band formed on an outer        edge of the outer bead sleeve; and    -   at least one inner bead sleeve positioned within at least one        inner bead positioned between the two opposing outer beads,        wherein each of the at least one inner bead sleeve comprises a        raised band spaced apart from two opposing ends of each of the        at least one inner bead sleeve.

403. The lysing tip of example 401, wherein the plurality of sleevescomprises a pair of outer bead sleeves positioned within two opposingouter beads of the plurality of beads, and wherein each of the pair ofouter bead sleeves comprises an inner tunnel comprising an internalledge at a transition between a smaller diameter portion of the innertunnel and a larger diameter portion of the inner tunnel.

404. The lysing tip of example 394, further comprising a plurality ofprotuberances positioned on the at least one lysing rod, wherein each ofat least a subset of the plurality of sleeves comprises a firstprotuberance positioned adjacent a first end of the sleeve and a secondprotuberance positioned adjacent a second end of the sleeve oppositefrom the first end so as to confine the sleeve to a predeterminedlocation on the at least one lysing rod.

405. The lysing tip of example 394, further comprising at least onespacer positioned in between at least two adjacent beads of theplurality of beads, wherein the at least one spacer is configured toconfine at least one sleeve of the plurality of sleeves to apredetermined location on the at least one lysing rod.

406. The lysing tip of example 394, wherein the at least one lysing rodcomprises at least one hollow lysing rod.

407. The lysing tip of example 406, wherein the at least one hollowlysing rod comprises at least one flattened section extending between atleast two adjacent beads of the plurality of beads.

408. The lysing tip of example 407, wherein the at least one flattenedsection comprises a leading distal edge extending at least substantiallytowards a treatment side of the lysing tip.

409. The lysing tip of example 394, wherein the plurality of sleevescomprises a pair of outer bead sleeves positioned within two opposingouter beads of the plurality of beads, wherein each of the pair of outerbead sleeves comprises an inner tunnel configured to receive the atleast one lysing rod, and wherein the inner tunnel of each of the outerbead sleeves comprises a taper from a larger diameter to a smallerdiameter.

410. The lysing tip of example 409, wherein coupling tips are formed onopposing ends of the at least one lysing rod, and wherein the taper ofeach of the inner tunnels of the outer bead sleeves is configured toengage one of the coupling tips.

411. The lysing tip of example 394, wherein the at least one lysing rodextends along a treatment side of the lysing tip, and wherein the lysingtip further comprises a support member extending along a side of thelysing tip opposite from the treatment side.

412. The lysing tip of example 411, wherein the support member defines abow shape, and wherein the support member is coupled at opposite ends ofthe support member to the at least one lysing rod.

413. The lysing tip of example 412, wherein the at least one lysing rodextends through openings in the support member formed at the oppositeends of the support member.

414. The lysing tip of example 394, wherein at least one of theplurality of beads comprises at least one facet comprising a flattenedregion formed on the at least one of the plurality of beads.

415. The lysing tip of example 394, further comprising a support memberextending along a side of the lysing tip opposite from the treatmentside, wherein the support member extends proximally behind each of aplurality of middle beads positioned between two opposing outer beadspositioned at opposite ends of the at least one lysing rod.

416. The lysing tip of example 415, wherein the lysing tip is configuredto perform in a relaxed configuration in which each of the middle beadsdoes not contact the support member and a flexed configuration in whichat least one of the middle beads contacts the support member.

417. The lysing tip of example 415, wherein at least a subset of theplurality of beads is configured to rotate about the at least one lysingrod, wherein the lysing tip is configured such that each of the middlebeads does not contact the support member in a relaxed configuration,and wherein the lysing tip is configured such that at least one of themiddle beads contacts the support member following sufficient rotationof the at least one of the middle beads about the at least one lysingrod so as to prevent further rotation.

418. The lysing tip of example 394, wherein each of the plurality ofbeads comprises at least one of a plastic, a gelatin, and a hydrogelmaterial.

419. The lysing tip of example 418, wherein each of the plurality ofbeads is overmolded onto one of the plurality of sleeves.

420. The lysing tip of example 394, wherein each of at least a subset ofthe plurality of beads comprises an at least substantially annular beadstructure.

421. The lysing tip of example 420, wherein each of the at least asubset comprises an annular bead structure having at least one of acircular shape and an oval shape in cross-section.

422. The lysing tip of example 420, wherein the plurality of beadscomprises a first outer bead, a second outer bead positioned oppositefrom the first outer bead, and at least one middle bead positioned inbetween the first outer bead and the second outer bead, wherein the atleast one middle bead defines a partial annular shape.

423. The lysing tip of example 422, wherein the at least one middle beadcomprises opposite ends each terminating in a knob at a proximal side ofthe at least one middle bead.

424. The lysing tip of example 420, wherein each of the at least asubset comprises a bead hub positioned within the annular beadstructure, and wherein each of the bead hubs is configured to couple theannular bead structure with one of the plurality of sleeves.

425. The lysing tip of example 424, wherein each of the at least asubset further comprises at least one spoke extending from the bead hubto the annular bead structure.

426. The lysing tip of example 424, wherein each of the at least asubset further comprises a bead hub frame extending continuously fromthe bead hub to the annular bead structure without protruding laterallybeyond an upper profile of the annular bead structure.

427. The lysing tip of example 420, wherein the at least one lysing rodcomprises a plurality of deformed regions corresponding with theplurality of sleeves so as to prevent each of the plurality of sleevesfrom being removed from a predefined region on the at least one lysingrod.

428. The lysing tip of example 420, wherein the plurality of beadscomprises a first outer bead, a second outer bead positioned oppositefrom the first outer bead, and at least one middle bead positioned inbetween the first outer bead and the second outer bead, wherein each ofthe first outer bead and the second outer bead defines a full annularstructure extending in a full perimeter about a respective sleeve of theplurality of sleeves, and wherein the at least one middle bead defines apartial annular structure extending in a partial perimeter about arespective sleeve the plurality of sleeves.

429. The lysing tip of example 428, wherein each of the at least onemiddle bead comprises knobs formed at opposing ends of the partialannular structure.

430. The lysing tip of example 428, wherein the at least one lysing rodextends along a treatment side of the lysing tip, wherein the lysing tipfurther comprises a support member extending along a side of the lysingtip opposite from the treatment side, and wherein the at least onemiddle bead is configured to operate in a relaxed configuration in whichthe at least one middle bead is spaced apart from the support member, afirst flexed configuration in which the at least one middle bead rotatesabout the lysing rod in a first direction and a first terminal end ofthe at least one middle bead contacts the support member to inhibitfurther rotation in the first direction, and a second flexedconfiguration in which the at least one middle bead rotates about thelysing rod in a second direction and a second terminal end of the atleast one middle bead opposite from the first terminal end contacts thesupport member to inhibit further rotation in the second direction.

431. The lysing tip of example 420, wherein the plurality of beadscomprises a first outer bead, a second outer bead positioned oppositefrom the first outer bead, and at least one middle bead positioned inbetween the first outer bead and the second outer bead, wherein each ofthe plurality of beads defines a full annular structure extending in afull perimeter about a respective sleeve of the plurality of sleeves.

432. The lysing tip of example 431, wherein each of the at least onemiddle bead comprises a full annular structure comprising a roundedleading end and a flattened trailing end.

433. The lysing tip of example 432, wherein the first outer bead and thesecond outer bead comprise a rounded leading end and a rounded trailingend.

434. The lysing tip of example 431, wherein each of the at least asubset comprises a bead hub positioned within the annular beadstructure, wherein each of the bead hubs is configured to couple theannular bead structure with one of the plurality of sleeves, and whereinthe first outer bead and the second outer bead are coupled directly toan interior surface of the full annular structure.

435. The lysing tip of example 420, wherein each of the plurality ofbeads comprises an annular structure, and wherein the annular structurecomprises an annular band structure.

436. The lysing tip of example 435, wherein the annular band structureis defined by an upper surface extending in a full perimeter about theannular band structure, wherein the annular band structure is furtherdefined by a lower surface extending in a full perimeter about theannular band structure, and wherein the upper surface is at leastsubstantially parallel to the lower surface about the full perimeter.

437. The lysing tip of example 435, wherein the annular band structurecomprises a resiliently flexible material such that the annular bandstructure can deform during a surgical procedure and automaticallyreturn to a relaxed configuration.

438. The lysing tip of example 437, wherein each of the plurality ofbeads comprises a bead hub positioned within the annular band structure,wherein each of the bead hubs is configured to couple the annular bandstructure with one of the plurality of sleeves.

439. The lysing tip of example 438, wherein each of the plurality ofbeads further comprises at least two spokes extending between the beadhub and the annular band structure.

440. The lysing tip of example 439, wherein the at least two spokescomprises only a first spoke extending between an upper portion of theannular band structure and a second spoke extending between a lowerportion of the annular band structure, and wherein the first spoke andthe second spoke are positioned and configured to allow the annular bandstructure to compress during a surgical procedure.

441. The lysing tip of example 440, wherein the first spoke and thesecond spoke are positioned and configured to allow the annular bandstructure to compress between an upper portion and a lower portion ofthe annular band structure and to compress between a distal portion anda proximal portion of the annular band structure.

442. The lysing tip of example 437, wherein the annular band structureis configured to compress during a surgical procedure to reduce across-sectional profile of the annular band structure between an upperend of the annular band structure and a lower end of the annular bandstructure.

443. The lysing tip of example 442, wherein the annular band structureis further configured such that, upon encountering sufficiently densetissue at a distal tip of the annular band structure, the at least onelysing rod advances in a distal direction relative to the annular bandstructure.

444. The lysing tip of example 442, wherein the annular band structureis configured to elongate between a distal end and a proximal end of theannular band structure as the annular band structure compresses toreduce the cross-sectional profile.

445. A system comprising the lysing tip of example 394, wherein thesystem further comprises:

-   -   a cannula configured to deliver the lysing tip therethrough; and    -   a deployment assembly configured to reposition the lysing tip        from a delivery configuration and a treatment configuration.

446. The system of example 445, wherein the deployment assemblycomprises a pair of actuation rods coupled to the lysing tip, whereinthe pair of actuation rods is configured to pivot the lysing tip betweenthe delivery and treatment configurations.

447. The system of example 446, wherein, in the delivery configuration,an axis of the at least one lysing rod extends along an axis of thecannula, and wherein, in the treatment configuration, the axis of the atleast one lysing rod extends at least substantially perpendicular to theaxis of the cannula outside of a distal opening of the cannula.

448. A system for delivery of tissue modification energy during asurgical procedure, the system comprising:

-   -   a tissue modification tip comprising an energy window configured        to deliver energy therethrough for modification of patient        tissue during a surgical procedure;    -   at least one cannula configured to deliver the tissue        modification tip therethrough; and    -   a deployment assembly comprising at least one actuation rod,        wherein the at least one actuation rod is configured to pivot        the tissue modification tip between a delivery configuration in        which an axis of the energy window extends along an axis of the        cannula and a treatment configuration in which the axis of the        energy window extends at least substantially perpendicular to        the axis of the cannula outside a distal opening of the at least        one cannula.

449. The system of example 448, wherein the at least one cannulacomprises an inner cannula and an outer cannula.

450. The system of example 449, wherein the tissue modification tip isconfigured to be fully received within the outer cannula in the deliveryconfiguration, and wherein the tissue modification tip is configured tobe unable to be fully received within the inner cannula in the deliveryconfiguration.

451. The system of example 448, wherein the energy window comprises anenergy window array comprising a plurality of isolated energy windowtermini.

452. The system of example 451, wherein the energy window is configuredto deliver electrosurgical energy through each of the plurality ofisolated energy window termini.

453. The system of example 452, wherein the energy window is configuredto deliver coagulation electrosurgical energy through each of theplurality of isolated energy window termini.

454. The system of example 451, wherein the energy window is configuredto deliver pulsed electrosurgical energy through each of the pluralityof isolated energy window termini.

455. The system of example 454, wherein the pulsed electrosurgicalenergy is configured such that, upon moving the tissue modification tipthrough a patient's tissue, intermittent islands of unmodified tissueare created in between tissue modified by the energy window.

456. The system of example 451, wherein at least a first subset of theplurality of isolated energy window termini is both physically andelectrically isolated from at least a second subset of the plurality ofisolated energy window termini.

457. The system of example 456, wherein each of the first subset of theplurality of isolated energy window termini is configured to deliver afirst modality of energy, and wherein the second subset of the pluralityof isolated energy window termini is configured to deliver a secondmodality of energy that differs from the first modality.

458. The system of example 457, wherein the first modality comprises anelectrosurgical energy of a first frequency, and wherein the secondmodality comprises an electrosurgical energy of a second frequencydistinct from the first frequency.

459. The system of example 448, wherein the at least one actuation rodcomprises:

-   -   a central actuation rod coupled to a central portion of the        tissue modification tip; and    -   a side actuation rod coupled at a first end of the side        actuation rod to the tissue modification tip adjacent a first        end of the tissue modification tip and coupled to the central        actuation rod at a second end of the side actuation rod opposite        from the first end of the side actuation rod.

460. The system of example 448, further comprising at least one canalconfigured to extend through the at least one cannula to deliver fluidto a surgical site adjacent to the tissue modification tip during asurgical procedure.

461. A system for delivery of tissue modification energy during asurgical procedure, the system comprising:

-   -   a tissue modification tip comprising an energy window configured        to deliver energy therethrough for modification of patient        tissue during a surgical procedure;    -   a grasping pad; and    -   a first instrument configured to selectively couple with the        tissue modification tip, wherein the first instrument is        configured to selectively couple with the tissue modification        tip at the grasping pad.

462. The system of example 461, wherein the energy window comprises anelongated energy window extending along an upper surface of the tissuemodification tip.

463. The system of example 462, wherein the tissue modification tipcomprises a plurality of bars extending across the elongated energywindow, and wherein the plurality of bars is configured to separate theelongated energy window into a plurality of isolated energy windows.

464. The system of example 463, wherein the elongated energy windowcomprises a primary axis extending from a first side of the elongatedenergy window to a second side of the elongated energy window oppositefrom the first side, and wherein each of the plurality of bars extendsacross the elongated energy window in a direction at least substantiallyperpendicular to the primary axis.

465. The system of example 461, wherein the energy window comprises aplurality of isolated energy window termini formed on an upper surfaceof the tissue modification tip.

466. The system of example 461, wherein the grasping pad is electricallycoupled with the energy window, and wherein the first instrument isconfigured to deliver energy to the energy window through the graspingpad while the tissue modification tip is coupled with the firstinstrument.

467. The system of example 461, further comprising an energy conduitcoupled with the energy window.

468. The system of example 467, wherein the energy conduit comprises awire extending from the energy window and configured to extend through alumen formed in the first instrument.

469. The system of example 461, wherein the energy window is configuredto deliver at least one of LASER, intense pulse light, resistantheating, radiant heat, thermochromic, ultrasound, and microwave energy.

470. The system of example 461, wherein the tissue modification tipfurther comprises at least one of an energy window tongue and an energywindow slot configured to couple with a corresponding slot or tongue ofthe first instrument, and wherein the at least one of an energy windowtongue and an energy window slot is configured to deliver energytherethrough to the energy window from the first instrument.

471. The system of example 470, wherein the tissue modification tipcomprises an energy window tongue formed on the grasping pad, whereinthe first instrument comprises a pair of jaws configured to grasp thegrasping pad, wherein the first instrument comprises an energy windowslot configured to receive the energy window tongue, and wherein theenergy window slot is formed on at least one of the pair of jaws.

472. An electrosurgical system, comprising:

-   -   a lysing tip configured for delivery of electrosurgical energy,        wherein the lysing tip comprises:        -   a first lysing tip portion comprising an energy delivery            side configured to receive and deliver electrosurgical            energy for one or more of tissue dissection and modification            and an orientational-deployment side opposite from the            energy delivery side;        -   a second lysing tip portion pivotably coupled with the first            lysing tip portion and comprising an energy delivery side            configured to receive and deliver electrosurgical energy for            one or more of tissue dissection and modification and an            orientational-deployment side opposite from the energy            delivery side, wherein the lysing tip is configured to be            repositioned between a delivery configuration in which the            energy delivery side of the first lysing tip portion is            positioned adjacent to the energy delivery side of the            second lysing tip portion and a treatment configuration in            which the energy delivery side of the first lysing tip            portion and the energy delivery side of the second lysing            tip portion collectively define an energy delivery side of            the lysing tip; and    -   a deployment assembly coupled with the lysing tip, wherein the        deployment assembly is configured to allow for selective        repositioning between the delivery configuration and the        treatment configuration.

473. The system of example 472, wherein each of the first tip portionand the second tip portion comprises a plurality of protrusions and atleast one recession positioned between at least two adjacent protrusionsin the plurality of protrusions.

474. The system of example 473, wherein the lysing tip comprises atleast one lysing member forming a lysing segment between each twoadjacent protrusions.

475. The system of example 473, wherein the lysing tip is configuredsuch that at least a subset of the plurality of protrusions of the firsttip portion nests within at least a subset of the at least one recessionof the second tip portion in the delivery configuration.

476. The system of example 472, wherein the first tip portion isconfigured to extend at least substantially parallel to the second tipportion in the delivery configuration.

477. The system of example 472, wherein the first tip portion isconfigured to extend adjacent to the second tip portion in the treatmentconfiguration such that the orientational-deployment side of the firsttip portion extends at least substantially co-planar relative to theorientational-deployment side of the second tip portion.

478. The system of example 472, wherein the lysing tip is configuredsuch that the first tip portion may be approximated with the second tipportion during a surgical procedure to clamp patient tissuetherebetween.

479. The system of example 472, wherein the lysing tip is configured tooperate in an intermediate configuration between the treatmentconfiguration and the delivery configuration, wherein, in theintermediate configuration, the orientational-deployment sides of thefirst and second tip portions extend at an acute angle relative to oneanother, and wherein the lysing tip is configured to deliverelectrosurgical energy to both the first and second tip portions in theintermediate configuration.

480. The system of example 472, wherein the first tip portion comprisesat least one lysing segment configured to deliver electrosurgical energytherethrough, wherein the second tip portion comprises at least onelysing segment configured to deliver electrosurgical energytherethrough, and wherein the at least one lysing segment of the firsttip portion is electrically isolated from the at least one lysingsegment of the second tip portion.

481. The system of example 480, wherein the lysing tip comprises abipolar lysing tip.

482. The system of example 472, wherein the lysing tip comprises abipolar lysing tip, wherein the first tip portion comprises at least onelysing segment configured to deliver electrosurgical energytherethrough, wherein the second tip portion comprises at least onelysing segment configured to deliver electrosurgical energytherethrough, and wherein the lysing tip is configured such that, in thetreatment configuration, each lysing segment of the first and second tipportions is configured to deliver electrosurgical energy of an oppositepolarity relative to each adjacent lysing segment of the first andsecond tip portions.

483. A method for electrosurgically treating patient tissue, the methodcomprising the steps of:

-   -   delivering a lysing tip through a first cannula in a delivery        configuration, wherein the lysing tip comprises:        -   a first lysing tip portion comprising an energy delivery            side configured to receive and deliver electrosurgical            energy for one or both of tissue dissection and modification            and an orientational-deployment side opposite from the            energy delivery side;        -   a second lysing tip portion pivotably coupled with the first            lysing tip portion and comprising an energy delivery side            configured to receive and deliver electrosurgical energy for            tissue dissection and/or modification and an            orientational-deployment side opposite from the energy            delivery side, wherein at least one of the energy delivery            side and the orientational-deployment side of both the first            lysing tip portion and the second lysing tip portion faces            an inner wall of the cannula in the delivery configuration;    -   reconfiguring the lysing tip to a treatment configuration by        pivoting the first lysing tip portion relative to the second        lysing tip portion; and    -   delivering electrosurgical energy to the first and second lysing        tip portions to treat patient tissue.

484. The method of example 483, wherein the lysing tip is configured inthe delivery configuration such that the energy delivery side of thefirst lysing tip portion faces the energy delivery side of the secondlysing tip portion.

485. The method of example 484, wherein the step of reconfiguring thelysing tip to a treatment configuration comprises pivoting the firstlysing tip portion relative to the second lysing tip portion such thatthe first lysing tip portion extends at an acute angle relative to thesecond lysing tip portion.

486. The method of example 485, further comprising:

-   -   positioning at least one of a duct and a blood vessel of a        patient in between the first lysing tip portion and the second        lysing tip portion; and    -   approximating the first and second lysing tip portions to clamp        the at least one of a duct and a blood vessel therebetween.

487. The method of example 484, wherein the step of reconfiguring thelysing tip to a treatment configuration comprises pivoting the firstlysing tip portion relative to the second lysing tip portion such thatthe first lysing tip portion is aligned with the second lysing tipportion and such that the energy delivery sides of the first and secondlysing tip portions extend in at least substantially the same direction.

488. The method of example 484, wherein the step of reconfiguring thelysing tip to a treatment configuration comprises pivoting the firstlysing tip portion relative to the second lysing tip portion such thatthe first lysing tip portion and the second lysing tip portion are atleast substantially perpendicular to an axis of the first cannula.

489. The method of example 488, wherein, in the treatment configuration,at least one of the first and second lysing tip portions extend beyond across-sectional profile of the first cannula.

490. The method of example 489, wherein, in the treatment configuration,both the first and second lysing tip portions extend beyond thecross-sectional profile of the first cannula.

491. A method for performing an electrosurgical procedure, the methodcomprising the steps of:

-   -   delivering a lysing tip through an entrance incision into a        patient's body in a delivery configuration, wherein the lysing        tip comprises:        -   a plurality of protrusions; and        -   at least one lysing segment positioned between at least two            adjacent protrusions in the plurality of protrusions;    -   reconfiguring the lysing tip to a treatment configuration; and    -   passing the lysing tip to a target tissue area within the        patient's body.

492. The method of example 491, wherein the step of delivering a lysingtip through an entrance incision into a patient's body in a deliveryconfiguration comprises delivering the lysing tip through a firstcannula into the patient's body in the delivery configuration.

493. The method of example 492, wherein the lysing tip extends at leastsubstantially along an axis of the first cannula in the deliveryconfiguration, and wherein the step of reconfiguring the lysing tip to atreatment configuration comprises pivoting the lysing tip outside of adistal end of the first cannula such that at least one end of twoopposing ends of the lysing tip extends beyond a cross-sectional profileof the first cannula.

494. The method of example 491, further comprising setting a thresholdtemperature for operation of the lysing tip.

495. The method of example 494, wherein the threshold temperaturecomprises at least one of a threshold temperature of patient tissue anda threshold temperature of at least a portion of the lysing tip.

496. The method of example 491, further comprising setting an energylevel for delivery of electrosurgical energy to the lysing tip.

497. The method of example 491, wherein the step of delivering thelysing tip comprises inserting the lysing tip through the entranceincision through a first cannula and releasing the lysing tip, andwherein the step of reconfiguring the lysing tip to a treatmentconfiguration comprises delivering a grasping/control instrument intothe patient's body adjacent to the lysing tip and coupling the lysingtip with the grasping/control instrument.

498. The method of example 491, further comprising deliveringelectrosurgical energy to the at least one lysing segment.

499. The method of example 491, further comprising:

-   -   obtaining sensor data;    -   comparing the sensor data with a threshold; and    -   upon detecting that a parameter of the sensor data has exceeded        the threshold, reducing energy delivered to the lysing tip.

500. The method of example 499, wherein the sensor data comprisestemperature data, and wherein the threshold comprises a temperaturethreshold.

501. The method of example 491, further comprising receiving locationdata associated with the lysing tip during a surgical procedure.

502. The method of example 501, wherein the step of receiving locationdata comprises receiving RFID tag data from an RFID tag located on thelysing tip.

503. The method of example 501, further comprising receiving temperaturedata from a temperature sensor on the lysing tip.

504. The method of example 503, further comprising combining thetemperature data and the location data.

505. The method of example 504, further comprising creating an imageusing both the temperature data and the location data.

506. The method of example 505, wherein the image allows a user todetermine which regions within a patient's body have been adequatelytreated using the lysing tip.

507. The method of example 505, wherein the image allows a user todetermine which regions within a patient's body have exceeded athreshold temperature resulting from use of the lysing tip.

508. The method of example 491, wherein the entrance incision comprisesa first length, wherein the lysing tip comprises a greatest dimension,and wherein the first length is less than the greatest dimension of thelysing tip.

509. The method of example 508, wherein the greatest dimension of thelysing tip is defined between a first outer protrusion of the pluralityof protrusions and a second outer protrusion of the plurality ofprotrusions opposite from the first outer protrusion.

510. The method of example 509, wherein the step of delivering thelysing tip comprises inserting the lysing tip through the entranceincision through a first cannula in the delivery configuration andextending the lysing tip through a distal opening of the first cannula,and wherein the step of reconfiguring the lysing tip to the treatmentconfiguration comprises rotating the lysing tip within the patient'sbody such that the greatest dimension is greater than a cross-sectionaldiameter of the first cannula and such that the lysing tip cannot bereceived back into the first cannula in the treatment configuration.

511. The method of example 510, wherein the step of delivering thelysing tip comprises inserting the lysing tip through the entranceincision through a first cannula extending over a second cannula.

512. The method of example 511, wherein the lysing tip is configuredsuch that it may not be received within the second cannula in thedelivery configuration.

513. The method of example 491, further comprising creating a path to atarget organ using the lysing tip.

514. The method of example 513, wherein the step of creating a path tothe target organ comprises activating an electrosurgical generator anddelivering electrosurgical energy from the electrosurgical generator tothe at least one lysing segment.

515. The method of example 513, further comprising identifying criticaltissue that is not to be treated using the lysing tip, and wherein thestep of creating the path to the target organ comprises creating a pathto the target organ that avoids the critical tissue.

516. The method of example 513, further comprising expanding the path tothe target organ using the lysing tip.

517. The method of example 516, wherein the plurality of protrusionscomprises a first outer protrusion and a second outer protrusionopposite from the first outer protrusion, wherein the first outerprotrusion extends in a first direction, wherein the second outerprotrusion extends in a second direction, and wherein the firstdirection extends at an angle relative to the second direction.

518. The method of example 517, wherein the step of expanding the pathto the target organ comprises using a side-to-side fanning motion toexpand the path.

519. The method of example 491, further comprising:

-   -   creating a path to a target organ using the lysing tip;    -   reconfiguring the lysing tip from the treatment configuration to        the delivery configuration;    -   withdrawing the lysing tip from the patient's body through the        entrance incision;    -   inserting a tissue modification tip comprising an energy window        configured to deliver energy therethrough into the patient's        body; and    -   extending the tissue modification tip through the path to the        target tissue area.

520. The method of example 519, further comprising at least one ofremoving an organ and accessing an organ at the target tissue area usingthe lysing tip.

521. The method of example 520, further comprising using the tissuemodification tip to achieve hemostasis at the target tissue area.

-   -   The method of example 520, wherein the organ comprises at least        one of a muscle, a parotid gland, a salivary gland, a thyroid        gland, a lung, a heart, a liver, a pancreas, a spleen, a        gallbladder, a kidney, an adrenal gland, a prostate, an ovary, a        uterus, a bladder, a blood vessel, a nerve, a lymph node, and a        bone.

522. The method of example 491, further comprising:

-   -   reconfiguring the lysing tip from the treatment configuration to        the delivery configuration; and    -   withdrawing the lysing tip from the patient's body.

523. The method of example 522, wherein the step of reconfiguring thelysing tip from the treatment configuration to the deliveryconfiguration comprises rotating the lysing tip such that a primary axisof the lysing tip extends at least substantially along a direction ofwithdrawal of the lysing tip.

524. The method of example 523 wherein the step of reconfiguring thelysing tip from the treatment configuration to the deliveryconfiguration comprises rotating the lysing tip such that a primary axisof the lysing tip extends at least substantially along an axis of acannula, and wherein the step of withdrawing the lysing tip compriseswithdrawing the lysing tip through the cannula.

525. The method of example 491, further comprising creating a path to asite of herniated tissue using the lysing tip.

526. The method of example 525, further comprising dissecting tissuearound the herniated tissue using the lysing tip to prepare the site forexcision of the herniated tissue.

527. The method of example 526, further comprising using the lysing tipto excise at least a portion of the herniated tissue.

528. The method of example 527, further comprising applying energy totissue remaining at the site following excision of the herniated tissue.

529. The method of example 528, wherein the step of applying energy toremaining tissue at the site following excision of the herniated tissuecomprises applying energy using at least one of the lysing tip and aseparate tissue modification tip.

530. The method of example 528, further comprising:

-   -   binding at least some of the remaining tissue; and    -   using at least one of the lysing tip and a separate tissue        modification tip to induce supportive fibrosis at the site.

531. The method of example 491, CNS access further comprising creating apath to at least one of the brain, spinal cord, and adjacent proximalnerves.

532. The method of example 491, further comprising creating a path to aperipheral nerve using the lysing tip.

533. The method of example 532, further comprising using the lysing tipto remove at least one of a tumor and fibrotic tissue from theperipheral nerve.

534. The method of example 533, wherein the step of using the lysing tipto remove at least one of a tumor and fibrotic tissue from theperipheral nerve is performed without delivering electrosurgical energyto the at least one lysing segment.

535. The method of example 534, wherein the step of creating a path to aperipheral nerve using the lysing tip is performed at least in partwhile delivering electrosurgical energy to the at least one lysingsegment.

536. The method of example 533, further comprising, following the stepof using the lysing tip to remove at least one of a tumor and fibrotictissue from the peripheral nerve:

-   -   activating the lysing tip so as to deliver electrosurgical        energy through the at least one lysing segment; and    -   inducing hemostasis at a site of removal of the at least one of        a tumor and fibrotic tissue using the lysing tip.

537. The method of example 491, further comprising using the lysing tipto create at least a portion of a tissue flap.

538. The method of example 537, wherein the tissue flap comprises atleast one of a skin flap, a muscle flap, and a mucosal flap.

539. The method of example 538, further comprising using the tissue flapin a breast reconstruction procedure wherein the tissue flap comprisesat least one of a latissimus dorsi flap and a transverse rectusabdominus myocutaneous flap.

540. The method of example 491, using the lysing tip to create at leasta portion of a tissue graft.

541. The method of example 541, wherein the tissue graft comprises atleast one of a skin graft, fat graft, fascial graft, vascular graft,connective tissue graft, and mucosal graft.

542. The method of example 491, further comprising:

-   -   creating a path to a target organ having a tumor using the        lysing tip; and    -   removing at least a portion of the tumor from the target organ.

543. The method of example 542, further comprising:

-   -   activating an electrosurgical generator to deliver        electrosurgical energy to the at least one lysing segment; and    -   using the lysing tip to induce hemostasis following removal of        the at least a portion of the tumor from the target organ.

544. The method of example 491, further comprising creating a tipdeployment pocket within the patient's body.

545. The method of example 544, wherein the tip deployment pocketcomprises a width running along or at least substantially parallel to alength of the entrance incision, and wherein the width of the tipdeployment pocket is greater than the length of the entrance incision.

546. The method of example 545, wherein the lysing tip comprises alysing tip length between a first outer protrusion of the plurality ofprotrusions and a second outer protrusion of the plurality ofprotrusions opposite from the first outer protrusion, and wherein thewidth of the tip deployment pocket is greater than or equal to thelysing tip length.

547. The method of example 546, wherein the width of the width of thetip deployment pocket is at least about 150% of the lysing tip length.

548. The method of example 544, wherein the tip deployment pocketcomprises a rectangular shape.

549. The method of example 544, wherein the tip deployment pocketcomprises a circular shape.

550. The method of example 544, wherein the step of creating a tipdeployment pocket comprises:

-   -   inserting a blunt instrument through the entrance incision; and    -   using the blunt instrument to separate tissue adjacent to the        entrance incision into upper and lower planes defining the tip        deployment pocket.

551. The method of example 544, wherein the step of creating a tipdeployment pocket is performed without using the lysing tip, and whereinthe step of creating a tip deployment pocket is performed before thestep of delivering a lysing tip through an entrance incision into apatient's body.

552. The method of example 551, wherein the step of delivering a lysingtip through an entrance incision into a patient's body comprisesdelivering the lysing tip through a cannula with an elongated axis ofthe lysing tip extending along an axis of the cannula.

553. The method of example 552, wherein the step of reconfiguring thelysing tip from the delivery configuration to the treatmentconfiguration comprises:

-   -   extending the lysing tip out of a distal end of the cannula into        the tip deployment pocket; and    -   rotating the lysing tip such that the elongated axis extends at        an at least substantially perpendicular angle relative to the        axis of the cannula in the tip deployment pocket.

554. The method of example 553, wherein the step of rotating the lysingtip comprises rotating the lysing tip such that at least one end of thelysing tip defining the elongated axis extends beyond a cross-sectionalprofile of the cannula.

555. The method of example 554, wherein the step of rotating the lysingtip comprises rotating the lysing tip such that both opposing ends ofthe lysing tip defining the elongated axis extend beyond across-sectional profile of the cannula.

556. The method of example 553, further comprising using the lysing tipto create a path to at least one of an apocrine gland and an eccrinegland.

557. The method of example 556, further comprising:

-   -   activating an electrosurgical generator to deliver        electrosurgical energy to the at least one lysing segment; and    -   using the lysing tip to apply electrosurgical energy to the at        least one of an apocrine gland and an eccrine gland to        incapacitate the at least one of an apocrine gland and an        eccrine gland.

558. The method of example 544, further comprising using a fluiddelivery canal to deliver fluid within the patient's body to a regionadjacent to the lysing tip during a surgical procedure using the lysingtip.

559. The method of example 544, further comprising:

-   -   using the lysing tip to create a path to a hair follicle region;    -   activating an electrosurgical generator to deliver        electrosurgical energy to the at least one lysing segment of the        lysing tip; and    -   using the lysing tip to apply electrosurgical energy to one or        more hair follicles in the hair follicle region, wherein the        electrosurgical energy results in the one or more hair follicles        being incapacitated.

560. The method of example 544, wherein the entrance incision is betweenabout 2 mm and about 12 mm in length, wherein the tip deployment pocketcomprises a width running along or at least substantially parallel tothe length of the entrance incision, and wherein the width of the tipdeployment pocket is greater than the length of the entrance incision.

561. The method of example 560, wherein the width of the tip deploymentpocket is greater than a length of the lysing tip extending between afirst outer protrusion of the plurality of protrusions and a secondouter protrusion of the plurality of protrusions opposite from the firstouter protrusion.

562. The method of example 560, wherein the width of the tip deploymentpocket is about 1 cm.

563. The method of example 562, wherein the tip deployment pocketcomprises a rectangular shape, wherein a length of the tip deploymentpocket extending at least substantially perpendicular to the width isbetween about 1 cm and about 2 cm.

564. The method of example 560, further comprising:

-   -   using the lysing tip to create a first path from the tip        deployment pocket to a first cellulite treatment zone; and    -   using the lysing tip to treat cellulite in the first cellulite        treatment zone.

565. The method of example 564, further comprising using the lysing tipto create a second path from the tip deployment pocket to the firstcellulite treatment zone.

566. The method of example 565, wherein the second path is angledrelative to the first path.

567. The method of example 564, further comprising:

-   -   using the lysing tip to create a second path from the tip        deployment pocket to a second cellulite treatment zone spaced        apart from the first cellulite treatment zone; and    -   using the lysing tip to treat cellulite in the second cellulite        treatment zone.

568. The method of example 564, wherein the step of using the lysing tipto treat cellulite in the first cellulite treatment zone comprises:

-   -   manipulating the first cellulite treatment zone to move a top        portion of the first cellulite treatment zone into the first        path; and    -   advancing the lysing tip into the first cellulite treatment zone        to treat cellulite in the top portion of the first cellulite        treatment zone.

569. The method of example 568, wherein the step of using the lysing tipto treat cellulite in the first cellulite treatment zone furthercomprises:

-   -   manipulating the first cellulite treatment zone to move a bottom        portion of the first cellulite treatment zone into the first        path; and    -   advancing the lysing tip into the first cellulite treatment zone        to treat cellulite in the bottom portion of the first cellulite        treatment zone.

570. The method of example 564, wherein the step of using the lysing tipto treat cellulite in the first cellulite treatment zone comprises:

-   -   delivering electrosurgical energy to the at least one lysing        segment; and    -   using the electrosurgical energy to denature tissues in the in        the first cellulite treatment zone.

571. The method of example 564, wherein a single entrance incision isused to treat cellulite in a first plurality of cellulite treatmentzones along the patient's first leg, and further comprising:

-   -   forming a second entrance incision;    -   forming a second tip deployment pocket; and    -   using the lysing tip to treat cellulite in a second plurality of        cellulite treatment zones along the patient's second leg from        the second entrance incision.

572. The method of example 544, wherein the step of creating a tipdeployment pocket comprises creating the tip deployment pocket adjacentto the entrance incision.

573. The method of example 544, further comprising:

-   -   reconfiguring the lysing tip from the treatment configuration to        the delivery configuration; and    -   withdrawing the lysing tip through the entrance incision.

574. The method of example 573, wherein the step of reconfiguring thelysing tip from the treatment configuration to the deliveryconfiguration comprises rotating the lysing tip such that an elongatedaxis of the lysing tip extends at least substantially in a withdrawaldirection.

575. The method of example 574, wherein the withdrawal direction extendsalong an axis of a cannula, and wherein the step of withdrawing thelysing tip comprises withdrawing the lysing tip through the cannula.

576. The method of example 491, further comprising creating a tipdeployment pocket within at least one of a patient's neck and head,wherein the surgical procedure comprises at least one of a facelift anda necklift procedure.

577. The method of example 576, further comprising forming at least onetreatment path using the lysing tip from the tip deployment pocket alongat least one of a patient's face and neck.

578. The method of example 577, wherein the step of forming at least onetreatment path comprises forming a plurality of overlapping treatmentpaths using the lysing tip from the tip deployment pocket along the atleast one of the patient's face and neck.

579. The method of example 578, further comprising activating the atleast one lysing segment to deliver electrosurgical energy to tissueadjacent to the at least one treatment path using the lysing tip.

580. The method of example 577, further comprising:

-   -   withdrawing the lysing tip from the entrance incision;    -   inserting a tissue modification tip comprising an energy window        configured to deliver energy therethrough through the entrance        incision; and    -   using the tissue modification tip to modify tissue adjacent to        the at least one treatment path to tighten the tissue adjacent        to the at least one treatment path.

581. The method of example 580, wherein the energy window is positionedon an upper surface of the tissue modification tip.

582. The method of example 581, wherein the step of using the tissuemodification tip to modify tissue adjacent to the at least one treatmentpath comprises positioning the energy window to face an upper surface ofthe at least one treatment path closer to an exterior surface of thepatient's skin.

583. The method of example 581, wherein the step of using the tissuemodification tip to modify tissue adjacent to the at least one treatmentpath comprises positioning the energy window to face a lower surface ofthe at least one treatment path further from an exterior surface of thepatient's skin.

584. The method of example 491, further comprising using the lysing tipto dissect the patient's scalp.

585. The method of example 491, further comprising:

-   -   forming a plurality of entrance incisions;    -   inserting the lysing tip within each of the entrance incisions;        and    -   using the lysing tip to dissect the patient's scalp adjacent to        each of the entrance incisions.

586. The method of example 491, further comprising creating a tipdeployment pocket adjacent to the patient's scalp.

587. The method of example 586, further comprising:

-   -   inserting the lysing tip in the tip deployment pocket; and    -   after inserting the lysing tip in the tip deployment pocket,        reconfiguring the lysing tip from the delivery configuration to        the treatment configuration in the tip deployment pocket.

588. The method of example 587, further comprising:

-   -   forming a plurality of entrance incisions adjacent to the        patient's scalp;    -   forming a plurality of tip deployment pockets adjacent to the        plurality of entrance incisions;    -   deploying the lysing tip in each of the plurality of tip        deployment pockets; and    -   forming a scalp dissection path using the lysing tip from each        of the tip deployment pockets to separate the patient's scalp        from its underlying structure.

589. The method of example 491, wherein the electrosurgical procedurecomprises installing at least one of a biomedical implant and a cosmeticimplant within the patient, and further comprising creating a path to alocation adjacent to an implant zone where the at least one of abiomedical implant and a cosmetic implant will be installed using thelysing tip.

590. The method of example 589, further comprising using the lysing tipto create an implant pocket in tissue in the implant zone, wherein theimplant pocket is configured to receive the at least one of a biomedicalimplant and a cosmetic implant.

591. The method of example 590, wherein the at least one of a biomedicalimplant and a cosmetic implant comprises a biomedical implant, andwherein the biomedical implant comprises at least one of a pump, apacemaker, a neurological implant, a drug delivery device, a trackingimplant, and an ID chip.

592. The method of example 590, wherein the at least one of a biomedicalimplant and a cosmetic implant comprises a cosmetic implant, and whereinthe cosmetic implant comprises at least one of a skin implant, a breastimplant, a face implant, and a muscle implant.

593. The method of example 590, further comprising:

-   -   forming a tip deployment pocket; and    -   deploying the lysing tip in the tip deployment pocket by        inserting the lysing tip in the tip deployment pocket and        reconfiguring the lysing tip from the delivery configuration to        the treatment configuration in the tip deployment pocket.

594. The method of example 593, wherein the tip deployment pocket isformed adjacent to the implant zone.

595. The method of example 593, wherein the tip deployment pocket isformed adjacent to the entrance incision.

596. The method of example 593, further comprising advancing the atleast one of a biomedical implant and a cosmetic implant to the implantzone and inserting the at least one of a biomedical implant and acosmetic implant in the implant pocket.

597. The method of example 491, wherein the electrosurgical procedurecomprises at least one of a capsulotomy and a capsulectomy.

598. The method of example 597, further comprising using the lysing tipto create a path to an implant having a capsule of scar tissue adjacentto the implant.

599. The method of example 598, further comprising using the lysing tipto separate at least a portion of the capsular fibrous tissue from theimplant.

600. The method of example 598, wherein the implant comprises a breastimplant.

601. The method of example 598, wherein the implant comprises a hipimplant.

602. An electrosurgical lysing tip, comprising:

-   -   a first outer protrusion;    -   a second outer protrusion opposite from the first outer        protrusion;    -   at least one inner bead positioned in between the first outer        protrusion and the second outer protrusion, wherein each of the        at least one inner bead defines an inner protrusion;    -   at least one lysing member defining at least one lysing segment        between each pair of adjacent protrusions; and    -   a support member extending between the first outer protrusion        and the second outer protrusion, wherein the support member is        configured to facilitate coupling of the lysing tip to a        surgical tool used to control the lysing tip during a surgical        procedure within a patient's body.

603. The electrosurgical lysing tip of example 602, wherein the firstouter protrusion is defined by a first outer bead, and wherein thesecond outer protrusion is defined by a second outer bead positioned onan opposite end of the lysing tip relative to the first outer bead.

604. The electrosurgical lysing tip of example 603, wherein each of thefirst outer bead and the second outer bead comprises a leading endprotruding distally of the at least one lysing member, and wherein eachof the first outer bead and the second outer bead comprises a trailingend protruding proximally from the support member.

605. The electrosurgical lysing tip of example 603, wherein the firstouter bead is non-rigidly coupled to the support member at a first endof the support member, and wherein the second outer bead is non-rigidlycoupled to the support member at a second end of the support memberopposite from the first end.

606. The electrosurgical lysing tip of example 603, wherein the firstouter bead and the second outer bead each comprises an inner recess, andwherein each inner recess is configured to receive a respective portionof the support member therein.

607. The electrosurgical lysing tip of example 606, wherein each innerrecess is configured to receive a respective end portion of the supportmember such that each opposing end of the support member terminates inan inner recess.

608. The electrosurgical lysing tip of example 606, wherein each innerrecess is configured to loosely receive a respective portion of thesupport member therein such that the first outer bead and the secondouter bead can move relative to the support member during a surgicalprocedure.

609. The electrosurgical lysing tip of example 602, wherein the firstouter protrusion comprises an integral portion of the support member ata first end of the support member, and wherein the second outerprotrusion comprises an integral portion of the support member at asecond end of the support member opposite from the first end.

610. The electrosurgical lysing tip of example 602, wherein the firstouter protrusion and the second outer protrusion each comprises a shapethat at least substantially mimics the shapes of each of the at leastone inner bead along a leading end of the first outer protrusion and thesecond outer protrusion.

611. The electrosurgical lysing tip of example 602, wherein the firstouter protrusion is defined by a first outer bead, wherein the secondouter protrusion is defined by a second outer bead positioned on anopposite end of the lysing tip relative to the first outer bead, andwherein the first outer bead and the second outer bead each comprises anat least substantially ellipsoidal shape.

612. The electrosurgical lysing tip of example 611, wherein each of theat least one inner bead comprises a leading end having an at leastsubstantially ellipsoidal shape.

613. The electrosurgical lysing tip of example 612, wherein each of theat least one inner bead further comprises a flattened trailing end.

614. The electrosurgical lysing tip of example 613, wherein each of theat least one inner bead comprises a flattened trailing end thatterminates adjacent to the support member.

615. An electrosurgical system, comprising:

-   -   a lysing tip comprising:        -   a plurality of beads; and        -   a lysing member extending through each of the plurality of            beads such that each of the plurality of beads protrudes            beyond the lysing member; and    -   a surgical tool configured to selectively couple with the lysing        tip, wherein the surgical tool comprises a pair of jaws        configured to selectively engage at least a portion of the        lysing tip.

616. The electrosurgical system of example 615, wherein the lysingmember comprises a first coupling tip formed at a first end of thelysing member and a second coupling tip formed at a second end of thelysing member opposite from the first end, and wherein the surgical toolis configured to selectively engage the lysing tip at the first couplingtip and the second coupling tip.

617. The electrosurgical system of example 616, wherein the lysingmember comprises a lysing rod comprising an at least substantiallycircular cross-section, and wherein the first and second coupling tipscomprise enlarged portions of the lysing rod.

618. The electrosurgical system of example 616, wherein the firstcoupling tip comprises an enlarged end, wherein the second coupling tipcomprises a second enlarged end, wherein a first jaw of the pair of jawsis configured to engage the first coupling tip at the first end, andwherein a second jaw of the pair of jaws is configured to engage thesecond coupling tip at the second end.

619. The electrosurgical system of example 615, wherein each of theplurality of beads is configured to rotate with respect to the lysingmember.

620. The electrosurgical system of example 615, further comprising aplurality of spacers coupled with the lysing member, wherein each of theplurality of spacers is positioned between a pair of adjacent beads ofthe plurality of beads.

621. The electrosurgical system of example 620, further comprising afirst outer spacer positioned in between a first outer bead of theplurality of beads and an adjacent bead and a second outer spacerpositioned in between a second outer bead of the plurality of beadsopposite from the first outer bead and an adjacent bead.

622. The electrosurgical system of example 615, wherein the surgicaltool is configured to deliver electrosurgical energy to the lysingmember when the lysing tip is selectively engaged with the surgicaltool.

623. The electrosurgical system of example 622, wherein the surgicaltool is configured to deliver electrosurgical energy to the lysing tipthrough at least one jaw of the pair of jaws.

624. The electrosurgical system of example 615, wherein each of theplurality of beads comprises an at least substantially ellipsoidalleading end.

625. The electrosurgical system of example 624, wherein each of theplurality of beads comprises a flattened trailing end.

626. An electrosurgical lysing tip, comprising:

-   -   a plurality of beads;    -   at least one lysing member extending at least partially through        each of the plurality of beads to couple the plurality of beads        together, wherein the at least one lysing member defines at        least one lysing segment between each pair of adjacent beads of        the plurality of beads;    -   a treatment portion coupled with the at least one lysing member;    -   a base portion removably couplable with the treatment portion        and configured such that, following an electrosurgical procedure        with the electrosurgical lysing tip, the treatment portion may        be removed from the base portion and a new treatment portion        with a new at least one lysing member and a new plurality of        beads coupled with the base portion for a subsequent        electrosurgical procedure.

627. The electrosurgical lysing tip of example 626, wherein the baseportion comprises at least one hole configured to couple the baseportion with a deployment assembly of a surgical instrument.

628. The electrosurgical lysing tip of example 626, wherein the baseportion and the treatment portion together define a support member forthe electrosurgical lysing tip, wherein the support member is configuredto facilitate coupling of the electrosurgical lysing tip to a surgicalinstrument used to control the lysing tip during an electrosurgicalprocedure within a patient's body.

629. The electrosurgical lysing tip of example 628, wherein thetreatment portion is configured to mate with the base portion such thatthe treatment portion defines a distal portion of the support member andthe base portion defines a proximal portion of the support member.

The features, structures, steps, or characteristics disclosed herein inconnection with one embodiment may be combined in any suitable manner inone or more alternative embodiments.

The term dissection may indicate the separation of tissues or of onetissue plane from another (ref: Free Online Medical Dictionary). Somealso consider dissection to comprise separation of a single tissue intoportions. Much of the bodies of animals and humans are formed fromembryonic fusion planes. Many of the organs of the human or animal bodymay be categorized from the embryonic fusion planes from whence theycame. The interfaces between organs may often be referred to as ‘tissueplanes.’ Such planes may be considered substantially planar dependingupon the size of a comparative planar living or inanimate object (suchas a surgical instrument). Some embodiments disclosed herein maycomprise cannula-delivered tissue dissectors (CDTD). Other embodimentsdisclosed herein may be used without a cannula and may therefore beconsidered non-cannula-delivered tissue dissectors (non-CDTD). Someembodiments may be used either with or without cannulas and therefore,depending upon the systems/procedure, may be considered CDTD ornon-CDTD. Both the CDTD and non-CDTD embodiments disclosed herein mayperform the functions of sharp dissection, blunt dissection,electrosurgical cutting and/or coagulation simultaneously without asurgeon having to switch instruments. Tissue modification may also becarried out.

Sharp dissection has been referred to by some as separation of tissuesby means of the sharp edge of a knife or scalpel or with the inner sharpedge of scissors. Blunt dissection has been defined by Webster assurgical separation of tissue layers by means of an instrument without acutting edge or by the fingers.

The term ‘minimally invasive surgery’ has been used to describe aprocedure (surgical or otherwise) that is less invasive than opensurgery used for the same purpose. Some minimally invasive procedurestypically involve use of laparoscopic and/or endoscopic devices andmanual and/or remote/computerized manipulation of instruments withindirect observation of the surgical field through an endoscope orsimilar device, and are carried out through the skin or through a bodycavity or anatomical opening. This may result in shorter hospital stays,or allow outpatient treatment (reference: Wikipedia).

Sometimes minimally invasive surgery is known as “keyhole” surgery andmay be performed using one or more trocars and one or more laparoscopesand/or endoscopes and/or cannulae to access tissues within the body.

The term ‘open surgery’ is used to indicate cutting skin and tissues to‘open the body’ so that the surgeon has direct access to the structuresor organs involved. An incision may of the size that permits a surgeon'shands to enter the patient's body. The structures and tissues involvedmay be seen and touched and may be directly exposed to the air of theoperating room.

The term “cannula,” as used herein, is intended to encompass any tube ortubular structure that is configured to be inserted into the body of ahuman or animal during a surgical procedure and facilitate selectivemovement of a surgical device and/or related components for performingdelivery of the surgical device and/or surgical procedures with thesurgical device. Tubular structures that contain fixedstructures/elements therein, such as needle drivers or graspinginstruments, are not considered cannulas as that term is used herein.Although often “trocars” are used in connection with cannulas, the termcannula, as used herein, is intended to encompass a trocar alone if sucha trocar is capable of being used to insert a medical device into abody.

It may be advantageous to have a spot coagulator extend from anembodiment of the CDTD at such a distance and/or location that allowscomplete viewing and/or contact of a bleeding area with a portion of thespot coagulator (for example the distal end point of a tip of thecoagulator). Such a probe may be deployable and may obtain electricalenergy off of a conductive element located between the lysing elementsof the tip and the plug.

BRIEF DESCRIPTION OF THE DRAWINGS

The written disclosure herein describes illustrative embodiments thatare non-limiting and non-exhaustive. Reference is made to certain ofsuch illustrative embodiments that are depicted in the figures, inwhich:

FIG. 1a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 1b is a perspective view of the embodiment previously depicted inFIG. 1a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 1c is a perspective view of the embodiment previously depicted inFIG. 1a in the delivery configuration.

FIG. 1d is an upper view of the lysing tip in FIG. 1a and the distalportions of the cannulas.

FIG. 1e is an upper view of lysing tip of the embodiment shown in FIG. 1a.

FIG. 1f is rear perspective view of the lysing tip and actuation arms ofthe embodiment shown in FIG. 1 a.

FIG. 1g is perspective view of the protrusion base of the embodimentshown in FIG. 1 a.

FIG. 1h is a perspective view of the lysing member of the embodimentshown in FIG. 1 a.

FIG. 1i is a side view of a hand assembly that may be used with theembodiment shown in FIG. 1 a.

FIG. 1j is perspective view of the embodiment shown in FIG. 1a used inconnection with a single cannula.

FIG. 2a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 2b is a perspective view of the embodiment previously depicted inFIG. 2a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 2c is a perspective view of the embodiment previously depicted inFIG. 2a in the delivery configuration.

FIG. 2d is an upper view of the lysing tip in FIG. 2a and the distalportion of the cannulas.

FIG. 2e is a perspective view of the embodiment previously depicted inFIG. 2a used in connection with a single cannula.

FIG. 3a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 3b is a perspective view of the embodiment previously depicted inFIG. 3a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 3c is a perspective view of the embodiment previously depicted inFIG. 3a in the delivery configuration.

FIG. 3d is an upper view of the lysing tip in FIG. 3a and the distalportion of the cannulas.

FIG. 3e is a perspective view of the embodiment previously depicted inFIG. 3a used in connection with a single cannula.

FIG. 4a is a perspective view of an embodiment of a system for deliveryof a bipolar lysing tip through a cannula in a treatment configuration.

FIG. 4b is a perspective view of the embodiment previously depicted inFIG. 4a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 4c is a perspective view of the embodiment previously depicted inFIG. 4a in the delivery configuration.

FIG. 4d is an upper view of the lysing tip in FIG. 4a and the distalportion of the cannulas.

FIG. 4e is a perspective view of the protrusion base of the embodimentpreviously depicted in FIG. 4 a.

FIG. 4f is a perspective view of the lysing members of the embodimentpreviously depicted in FIG. 4 a.

FIG. 4g is a rear perspective view of the embodiment previously depictedin FIG. 4a including the rear of the lysing tip and the actuation rods.

FIG. 4h is a perspective view of the embodiment previously depicted inFIG. 4a used in connection with a single cannula.

FIG. 5a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 5b is a perspective view of the embodiment previously depicted inFIG. 5a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 5c is a perspective view of the embodiment previously depicted inFIG. 5a in the delivery configuration.

FIG. 5d is an upper view of the lysing tip in FIG. 5a and the distalportion of the cannulas.

FIG. 5e is a perspective view of the embodiment previously depicted inFIG. 5a used in connection with a single cannula.

FIG. 6a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 6b is a perspective view of the embodiment previously depicted inFIG. 6a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 6c is a perspective view of the embodiment previously depicted inFIG. 6a in the delivery configuration.

FIG. 6d is an upper view of the lysing tip in FIG. 6a and the distalportion of the cannulas.

FIG. 6e is a perspective view of the embodiment previously depicted inFIG. 6a used in connection with a single cannula.

FIG. 7a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula via a grasping/control instrument.

FIG. 7b is an upper plan view of the embodiment previously depicted inFIG. 7 a.

FIG. 7c is a close-up side view of the embodiment previously depicted inFIG. 7a wherein a lysing tip is reattached.

FIG. 7d is an upper plan view of the lysing tip of the embodimentpreviously depicted in FIG. 7 a.

FIG. 7e is a side view of the embodiment previously depicted in FIG. 7a, wherein the lysing tip is uncoupled from the grasping/controlinstrument.

FIG. 7f is a side view of the grasping/control instrument of theembodiment previously depicted in FIG. 7 a.

FIG. 8a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a single cannula via a grasping/controlinstrument further comprising a tether.

FIG. 8b is a close-up side view of the distal end of the embodimentpreviously depicted in FIG. 8a wherein the tip is coupled to theinstrument tip.

FIG. 8c is a close-up side view of the distal end of thegrasping/control instrument of the embodiment previously depicted inFIG. 8 a.

FIG. 8d is a close-up, cross-sectional side view of the distal end ofthe embodiment previously depicted in FIG. 8a wherein the tip is coupledto the instrument tip.

FIG. 8e is a close-up perspective view of the distal end of theembodiment previously depicted in FIG. 8a wherein the tip is uncoupledfrom the instrument tip yet tethered.

FIG. 8f is a close-up perspective view of the distal end of theembodiment previously depicted in FIG. 8a wherein the tip is uncoupledfrom the instrument tip yet tethered and upside down.

FIG. 9 is an upper plan view of a non-axial lysing tip.

FIG. 10a is a perspective view of yet another embodiment of a system fordelivery of a lysing tip through a cannula in a treatment configuration.

FIG. 10b is an upper plan, close-up view of the embodiment previouslydepicted in FIG. 10a in a treatment configuration.

FIG. 10c is a close-up upper plan view of the embodiment previouslydepicted in FIG. 10a showing beads, protuberances, and lysing tip.

FIG. 10d is a side view through the tunnel of a bead of the embodimentpreviously depicted in FIG. 10 a.

FIG. 10e is a close-up, upper plan view of the lysing tip depicted inFIG. 10c illustrating the lysing tip in a stressed/deformed state.

FIG. 10f is an upper view of the embodiment previously depicted in FIG.10a with lysing tip in delivery configuration.

FIG. 10g is a side view of the embodiment previously depicted in FIG.10a illustrating the coupling of the lysing member to the actuation rod.

FIG. 10h is an upper view of the embodiment previously depicted in FIG.10f illustrating that tip may not fit within one or more cannulas.

FIG. 11a is a perspective plan view of an embodiment of a system fordelivery of a lysing tip through a cannula in a treatment configuration.

FIG. 11b is an upper plan, close-up view of the embodiment previouslydepicted in FIG. 11a in a treatment configuration.

FIG. 11c is a close-up upper plan view of the embodiment previouslydepicted in FIG. 11a showing beads, a spacer, and lysing tip.

FIG. 11d is a side view through the tunnel of a bead with facetscomprising the embodiment previously depicted in FIG. 11 a.

FIG. 11e is a close-up upper plan view of the lysing tip depicted inFIG. 11c illustrating the lysing tip in a stressed/deformed state withspacers.

FIG. 11f is an upper view of the embodiment previously depicted in FIG.11b illustrating that tip may not fit within one or more cannulas.

FIG. 12a comprises a perspective view of a lysing member/lysing rod witha circular cross-section.

FIG. 12b comprises a perspective view of a lysing member/lysing rod witha triangular cross-section.

FIG. 12c comprises a perspective view of a lysing member/lysing rod witha rectangular cross-section.

FIG. 12d comprises a perspective view of a lysing member/lysing rod witha pentagonal cross-section.

FIG. 12 dx comprises a perspective view of a lysing member/lysing rodhaving a pentagonal cross section that is twisted along its length.

FIG. 12e comprises a perspective view of a lysing member/lysing rod witha hexagonal cross-section.

FIG. 12f comprises a perspective view of a lysing member/lysing rod witha wedge cross-section.

FIG. 12g comprises a perspective view of a lysing member/lysing rod witha half-circle cross-section.

FIG. 12h comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section with non-beveledends.

FIG. 12i comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section with beveledends.

FIG. 12j comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section with beveledends and holes.

FIG. 12k comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section arced along itslength.

FIG. 12L comprises a perspective view of a spacer to a lysing tip withopposing loops connected by a rod in a relaxed state.

FIG. 12m comprises a perspective view of a spacer to a lysing tip withopposing loops connected by a rod in a stressed state.

FIG. 12n comprises a perspective view of a spacer to a lysing tip with ahole through its length having a triangular cross-section.

FIG. 12o comprises a perspective view of a spacer to a lysing tip with ahole through its length having a rectangular cross-section.

FIG. 12p comprises a perspective view of a spacer to a lysing tip with ahole through its length having a pentagonal cross-section.

FIG. 12 px comprises a perspective view of a spacer to a lysing tip witha hole through its length having a pentagonal cross section that istwisted along its length.

FIG. 12q comprises a perspective view of a spacer to a lysing tip with ahole through its length having a hexagonal cross-section.

FIG. 12r comprises a perspective view of a spacer to a lysing tip with ahole through its length having a blade-shaped cross-section with roundededges.

FIG. 12s comprises a perspective view of a spacer to a lysing tip with ahole through its length having a blade-shaped cross-section with flatedges.

FIG. 12t comprises a perspective view of a spacer to a lysing tip with ahole through its length having a spindle cross-section.

FIG. 12 aa is a perspective view of a bead having a spherical shape.

FIG. 12 bb is a perspective view of a bead having a wheel shape.

FIG. 12 cc is a perspective view of a bead having a dodecahedron shape.

FIG. 12 dd is a perspective view of a bead having a substantiallyellipsoidal shape.

FIG. 12 ee is a perspective view of a bead having a substantiallyellipsoidal shape with facets.

FIG. 12 ff is a perspective view of a bead having a substantiallyellipsoidal shape able to accept a sleeve.

FIG. 12 gg is a perspective view of a bead having a partiallyellipsoidal shape with a flat proximal end and facets.

FIG. 12 hh is a perspective view of a bead having a partiallyellipsoidal shape with two flat surfaces on its proximal end.

FIG. 12 ii is an upper view of a bead having a partially ellipsoidalwith convex proximal end.

FIG. 12 jj is an upper view of a bead having a partially ellipsoidalshape with an asymmetric proximal end with facets.

FIG. 12 kk is an upper view of a bead having a partially ellipsoidalshape with an angular cut-out on its proximal end.

FIG. 12LL is an upper view of a bead having a partially ellipsoidalshape with a concave proximal end.

FIG. 12 mm is a side view, from the outside, of an outer bead having asubstantially annular shape.

FIG. 12 nn is a side view, from the inside, of bead depicted in FIG. 12mm.

FIG. 12 oo is a side view of a deformable bead having a substantiallyannular shape.

FIG. 12 pp is a side view of a middle bead having a substantiallyannular shape and knobs on its proximal end.

FIG. 12 qq is a side view of a middle bead having a substantiallyannular shape and a cross-member at its proximal end.

FIG. 12 rr is a side perspective view of a bead comprising a slotconfigured to engage a lysing member.

FIG. 13a is a perspective view of an embodiment of a system for deliveryof a lysing tip comprising a bar through a cannula in a treatmentconfiguration.

FIG. 13b is a perspective view of the embodiment previously depicted inFIG. 13a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 13c is a perspective view of the embodiment previously depicted inFIG. 13a in the delivery configuration.

FIG. 13d is an upper view of the lysing tip in FIG. 13a and the distalportion of the cannulas.

FIG. 13e is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 13 a.

FIG. 13f is an upper view of the assembled lysing tip with actuationarms of the embodiment previously depicted in FIG. 13 a.

FIG. 13g is an upper view of the embodiment previously depicted in FIG.13a , more specifically of the lysing tip without actuation arms.

FIG. 13h is an upper view of the lysing bar comprising the embodiment.

FIG. 13i is a side view of the lysing tip.

FIG. 14a is an upper perspective view of an alternative embodiment of alysing tip delivered through one or more cannulas in the treatmentconfiguration.

FIG. 14b is an upper perspective view of the embodiment in FIG. 14a in apartially deployed configuration, between the treatment and deliveryconfigurations.

FIG. 14c is an upper perspective view of the embodiment in FIG. 14a in adelivery configuration.

FIG. 14d is an upper view of the lysing tip in FIG. 14a and the distalportion of the cannulas.

FIG. 14e is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 14 a.

FIG. 14f is a side view of the lysing tip of the embodiment previouslydepicted in FIG. 14 a.

FIG. 14g is an upper view of the embodiment previously depicted in FIG.14a , more specifically of the lysing tip without actuation arms.

FIG. 14h is an upper view of the lysing tip with certain componentsremoved to view structures beneath.

FIG. 14i is a perspective view of lysing tip in the deliveryconfiguration being too large to enter the inner cannula but ofsufficient dimensions to enter the outer cannula.

FIG. 14j is an upper perspective view of FIG. 14 i.

FIG. 14k is a perspective view of the lysing tip of FIG. 14j in thedelivery configuration with an inner cannula having a diameter smallerthan tip width of the lysing tip.

FIG. 14L is a perspective view of the embodiment of FIG. 14k without theouter cannula.

FIG. 14m is a perspective view of the lysing tip of FIG. 14k in thedelivery configuration with an inner cannula having a diameter smallerthan tip width of the lysing tip which is covered by a protectivesleeve.

FIG. 14n is a perspective view of the embodiment of FIG. 14L without theouter cannula with the lysing tip covered by a protective sleeve.

FIG. 14o is a perspective view of an alternative embodiment to thatdepicted in FIG. 14a in which a treatment portion may be removed fromthe lysing tip.

FIG. 14p is a perspective view of cross section taken along line A-Afrom FIG. 14 r.

FIG. 14q is a perspective view of the treatment portion of theembodiment depicted in FIG. 14 o.

FIG. 14r is an exploded perspective view of the lysing tip of theembodiment of FIG. 14 o.

FIG. 14s is an exploded, side perspective cross-sectional view takenalong line A-A from FIG. 14r

FIG. 14t is an exploded, side cross-sectional view taken along line A-Afrom FIG. 14 r.

FIG. 15a is an upper perspective view of an alternative embodiment of alysing tip delivered through one or more cannulas in the treatmentconfiguration, said lysing tip being configured with one or more energywindows.

FIG. 15b is an upper view of the embodiment previously depicted in FIG.15a , more specifically of the lysing tip with one or more energywindows and actuation arms.

FIG. 15c is a front view of lysing tip of the embodiment previouslydepicted in FIG. 15a with energy window strip.

FIG. 15d is a close-up side view of lysing tip of the embodimentpreviously depicted in FIG. 15a with energy window strip.

FIG. 15e is perspective close-up view of a bead of the embodimentpreviously depicted in FIG. 15 a.

FIG. 15f is a front view showing lysing tip of the embodiment previouslydepicted in FIG. 15a with energy window recessed within one or morecannulas.

FIG. 15g is an exploded view of an energy window.

FIG. 15h is a front view of the insulation cover of the embodimentpreviously depicted in FIG. 15 a.

FIG. 15i is a close-up sectioned side view of the outer bead showing theinsertion of the insulation cover through the bead.

FIG. 15j is a perspective view of a bipolar lysing tip of the embodimentof FIG. 15 a.

FIG. 15k is an upper plan view of a bipolar lysing tip of the embodimentof FIG. 15 a.

FIG. 16a is an upper plan view of a bipolar embodiment of a CDTD systemin the treatment configuration.

FIG. 16b is a perspective view of the embodiment previously depicted inFIG. 16a in a partially retracted configuration, in between the deliveryand treatment configurations.

FIG. 16c is a perspective view of the embodiment previously depicted inFIG. 16a in the delivery configuration.

FIG. 16d is an upper view of the lysing tip in FIG. 16a and the distalportion of the cannulas.

FIG. 16e is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 16 a.

FIG. 16f is an upper view of the lysing tip of the embodiment previouslydepicted in FIG. 16 a.

FIG. 16g is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 16 a.

FIG. 16h is a rear view of the beads and wiring of the embodimentpreviously depicted in FIG. 16 a.

FIG. 17a is an upper plan view of an embodiment of a lysing tip.

FIG. 17b is a cross sectional view of the embodiment previously depictedin FIG. 17a at the location shown in FIG. 17 a.

FIG. 17c is an upper plan view of yet another embodiment of a lysingtip.

FIG. 17d is an upper plan view of still another embodiment of a lysingtip.

FIG. 17e is a perspective view of the structural member coupled withlysing rod.

FIG. 17f is a partial breakaway view of the delivery of lysing tip andgrasping/control instrument inside a body, said lysing tip to bereceived and held by a second instrument until the grasping/controlinstrument grasps and controls lysing tip for the surgical procedure.

FIG. 17g is a perspective view of the interaction between a lysing tip,its grasping/control instrument, and a temporary holding/graspinginstrument.

FIG. 17h is a side view of a lysing tip and its associated graspingcontrol instrument without a non-conductive sheath.

FIG. 17i is a side view of a lysing tip and its associated graspingcontrol instrument covered by a non-conductive sheath.

FIG. 17j is an upper view of a lysing tip depicting middle beads heldvia friction fit and protuberances.

FIG. 17k is a front view of a lysing tip depicting deformed lysing rodbetween beads.

FIG. 17L is a view of the abdomen depicting the construction of asurgical device to be used therein.

FIG. 17m is a top plan view of a modular lysing tip depicting internalcomponents of a locking mechanism.

FIG. 18a is a perspective view of a system comprising a lysing tip andgrasping/control instrument, coupled.

FIG. 18b is an upper plan view of a lysing tip and grasping controlinstrument, coupled.

FIG. 18c is a perspective view of a lysing tip and grasping/controlinstrument, uncoupled.

FIG. 18d is a side view of an outer bead, being the inside view of theouter bead.

FIG. 18e is a side view of an outer bead, being the outside view of theouter bead.

FIG. 19a is an upper plan view of a lysing tip comprising a tab.

FIG. 19b is a side view of a grasping control instrument configured tocouple with the lysing tip in FIG. 19 a.

FIG. 19c is top view of the lysing tip of the embodiment of FIG. 19acoupled with an energy strip.

FIG. 19d is front view of the lysing tip of the embodiment of FIG. 19acoupled with an energy strip.

FIG. 20a is a perspective view of system comprising a lysing tipcomprising two outer beads and configured to be used with acorresponding grasping/control instrument that defines a third innerbead when coupled.

FIG. 20b is a perspective view of the embodiment in FIG. 20a , withlysing tip uncoupled from its corresponding grasping/control instrument.

FIG. 20c is an upper plan view of the embodiment of FIG. 20a , withlysing tip and its corresponding grasping/control instrument.

FIG. 20d is a perspective view of the embodiment of FIG. 20a of thelysing plate and its associated side beads.

FIG. 20e is a side view of the embodiment of FIG. 20a of the lysing tipillustrating the positioning of lysing plate within bead.

FIG. 20f is an upper view of the embodiment of FIG. 20a of the lysingplate and associated side beads.

FIG. 20g is a front view of the embodiment of FIG. 20a of lysing plateand associated side beads.

FIG. 20h is an upper view of the embodiment of FIG. 20a of lysing plate.

FIG. 20i is a perspective view of an alternative embodiment to thedevice depicted in of FIG. 20a in which the lysing member comprises acircular cross section.

FIG. 20j is a side view of a bead from the embodiment of FIG. 20idepicting a hole that makes contact with lysing member and a rod tunnelthat does not extend through bead.

FIG. 20k is a side view of a bead from the embodiment of FIG. 20idepicting a hole that makes contact with lysing member and a rod tunnelthat does extend through bead.

FIG. 20L is a top view of the lysing tip of FIG. 20i comprising only arod and beads.

FIG. 20m is a top view of the lysing tip of FIG. 20i comprising a spacerand beads.

FIG. 20n is a top view of the lysing tip of FIG. 20i comprising a rod,partial spacer and beads.

FIG. 20o is a side view of a grasping control instrument depicted inFIG. 20i with a modified distal jaw shape comprising an overbite shape.

FIG. 21a is a perspective view of an alternative embodiment of a systemcomprising a 2-bulb lysing tip and its associated grasping/controlinstrument, coupled.

FIG. 21b is a perspective view of the lysing tip and its associatedgrasping/control instrument, uncoupled.

FIG. 21c is a side view of the embodiment depicted in FIG. 21 a.

FIG. 21d is an upper plan view of a lysing tip coupled with agrasping/control instrument depicting hidden lines of internalcomponents of a bead on one side.

FIG. 21e is an upper exploded view showing beads removed from lysingsegment.

FIG. 22a is a perspective view of an alternative embodiment of a systemcomprising a 2-bulb lysing tip with beads rounded on the proximal endsand its associated grasping/control instrument, coupled.

FIG. 22b is a perspective view of the lysing tip and its associatedgrasping/control instrument, uncoupled.

FIG. 22c is a side view of the embodiment depicted in FIG. 22 a.

FIG. 22d is an upper plan view of a lysing tip coupled with agrasping/control instrument.

FIG. 22e is an upper exploded view showing beads removed from lysingsegment.

FIG. 23a is an upper plan view of an alternative embodiment of a systemcomprising a 2-bulb lysing tip illustrating use of cords for retrieval.

FIG. 23b is a side view of the embodiment depicted in FIG. 23a of thelysing tip and its associated grasping/control instrument, uncoupled.

FIG. 23c is a perspective view of the embodiment depicted in FIG. 23 a.

FIG. 23d is an upper view of the grasping plate and lysing member of theembodiment depicted in FIG. 23 a.

FIG. 24a is a perspective view of a lysing tip configured to couple withan electrosurgical pencil.

FIG. 24b is an upper view of the lysing tip of FIG. 24a coupled to anelectrosurgical pencil.

FIG. 24c is a perspective view of an alternative lysing tip configuredto couple to an electrosurgical pencil.

FIG. 25a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a single cannula via a grasping/controlinstrument further comprising a tether.

FIG. 25b is a close-up side view of the embodiment depicted in FIG. 25aof the distal end of the embodiment previously depicted in FIG. 25awherein the tip is coupled to the instrument tip.

FIG. 25c is a close-up side view of the embodiment depicted in FIG. 25aof the distal end of the grasping/control instrument of the embodimentpreviously depicted in FIG. 25 a.

FIG. 25d is a close-up, cross-sectional side view of the distal end ofthe embodiment previously depicted in FIG. 25a wherein the tip iscoupled to the instrument tip.

FIG. 25e is a close-up perspective view of the distal end of theembodiment previously depicted in FIG. 25a wherein the tip is uncoupledfrom the instrument tip yet tethered and may contain magnets.

FIG. 26a is an elevated view of a lysing tip comprising a non-axialconfiguration in which the middle spacer is removed.

FIG. 26b is an elevated view of a lysing tip comprising a non-axialconfiguration in which the middle spacer is present.

FIG. 27a is an upper plan perspective view of an alternative embodimentfor a lysing tip comprising beads with associated sleeves.

FIG. 27b is a perspective view of a lysing tip showing two beads removedto expose internal components.

FIG. 27c is an upper plan view showing two beads removed to exposeinternal components.

FIG. 27d is the exploded perspective view of one end of a lysing tip toshow how a bead is coupled with a lysing rod.

FIG. 27e is a perspective view of a side bead.

FIG. 27f are perspective views of an outer sleeve illustrating the twoends of the sleeve.

FIG. 27g is a side view of an outer bead.

FIG. 27h is a side perspective view of a middle bead coupled to lysingrod.

FIG. 27i is the exploded perspective view of a middle bead to show how abead is coupled with a lysing rod and sleeve.

FIG. 27j is a perspective view of an outer sleeve illustrating the outertunnel being tapered.

FIG. 28a is an upper plan perspective view of an alternative embodimentfor a lysing tip.

FIG. 28b is an upper view of the lysing tip of the embodiment of FIG. 28a.

FIG. 28c is a distal view of the embodiment of FIG. 28 a.

FIG. 28d is side view of the lysing tip of the embodiment of FIG. 28 a.

FIG. 28e is a perspective view of a side bead of the embodiment of FIG.28 a.

FIG. 28f is a side view of the annular bead of the embodiment of FIG. 28a.

FIG. 28g is an upper view of a side bead coupled to lysing rod.

FIG. 28h is the exploded perspective view of a side bead to show how abead is coupled with a lysing rod and sleeve.

FIG. 28i is a side perspective view of a middle bead coupled to lysingrod.

FIG. 28j is a side view of a middle bead.

FIG. 28k is an upper view of a middle bead coupled to lysing rod.

FIG. 28L is a perspective exploded view of a bead and correspondingsleeve coupled to lysing rod.

FIG. 29a is an upper plan perspective view of an alternative embodimentfor a lysing tip.

FIG. 29b is an upper view of the lysing tip of the embodiment of FIG. 29a.

FIG. 29c is a side view of the embodiment of FIG. 29 a.

FIG. 29d is side view of the middle bead of the embodiment of FIG. 29 a.

FIG. 29e is a perspective view of the lysing rod and its components with2 beads removed to expose internal components.

FIG. 29f is a perspective exploded view of an outer annular bead of theembodiment of FIG. 29a demonstrating how it is coupled with lysing rodand sleeve.

FIG. 30a is an upper plan perspective view of an alternative embodimentfor a lysing tip.

FIG. 30b is an upper view of the lysing tip of the embodiment of FIG. 30a.

FIG. 30c is a side view of the embodiment of FIG. 30 a.

FIG. 30d is side view of the middle bead of the embodiment of FIG. 30aand corresponding sleeve coupled to lysing rod.

FIG. 30e is a perspective view of an outer bead in an uncompressedstate.

FIG. 30f is a perspective view of an outer bead in a compressed state.

FIG. 30g is a perspective view of an outer sleeve of the embodiment ofFIG. 30 a.

FIG. 30h is a side view of an outer bead in an uncompressed state.

FIG. 30i is a side view of an outer bead in a compressed state.

FIG. 30j is an upper view of an outer bead in an uncompressed state.

FIG. 30k is an upper view of an outer bead in a compressed state.

FIG. 31a is a perspective view of an embodiment of a system for deliveryof a lysing tip through a cannula in a treatment configuration.

FIG. 31b is a close-up perspective view of the embodiment depicted inFIG. 31a comprising the middle beads depicted in FIG. 28 a.

FIG. 31c is a close-up perspective view of the embodiment depicted inFIG. 31a comprising the middle beads depicted in FIG. 27 a.

FIG. 31d is a close-up perspective view of the embodiment depicted inFIG. 31a comprising the middle beads depicted in FIG. 29 a.

FIG. 31e is a close-up perspective view of the embodiment depicted inFIG. 31a comprising the middle beads depicted in FIG. 30 a.

FIG. 32a is a perspective view of an embodiment of a TMT coupled to acannula with actuating rods and canal in the treatment configuration.

FIG. 32b is a perspective view of the embodiment of FIG. 32a in betweenthe treatment and delivery configurations without canal.

FIG. 32c is a perspective view of the embodiment of FIG. 32a in thedelivery configuration without canal.

FIG. 33a is a perspective view of a TMT comprising an energy bar coupledto a grasping/control instrument with energy conduit visible.

FIG. 33b is a side view of the embodiment depicted in FIG. 33a with TMTuncoupled from grasping/control instrument with energy conduit visible.

FIG. 33c is a perspective view of a cover to the TMT depicted in FIG. 33a.

FIG. 33d is a perspective view of the energy bar and members to the TMTdepicted in FIG. 33 a.

FIG. 33e is a perspective view of a TMT and its associatedgrasping/control instrument and an alternative embodiment of an energyconduit.

FIG. 33f is a top plan view of the embodiment depicted in FIG. 33adepicting the energy window tip in a delivery configuration and coupledto a modular instrument tip.

FIG. 34a is an upper view of a dissector/tissue clamp system in thetreatment/dissection configuration.

FIG. 34b is an upper view of the dissector/tissue clamp system depictedin FIG. 34a with jaws in an intermediate configuration.

FIG. 34c is an upper view of the dissector/tissue clamp system depictedin FIG. 34a with jaws clamped.

FIG. 34d is an upper view of the dissector/tissue clamp system depictedin FIG. 34a in the delivery configuration.

FIG. 34e is an upper view of the dissector/tissue clamp system depictedin FIG. 34a with outer cannula removed.

FIG. 34f is an exploded view of the parts of the tip of the embodimentdepicted in FIG. 34 a.

FIG. 34g is a rear perspective view of the parts depicted in FIG. 34fcoupled.

FIG. 34h is an example of a bipolar embodiment of the system depicted inFIG. 34 a.

FIG. 34i is an alternative embodiment of the bipolar system depicted inFIG. 34 h.

FIG. 35a is a perspective view of an alternative embodiment of a systemcomprising a rotatable lysing tip and associated grasping/controlinstrument and cannula.

FIG. 35b is a perspective view of the embodiment of FIG. 35a with lysingtip rotated.

FIG. 35c is a close-up side rear view of the lysing tip of theembodiment of FIG. 35a with upper jaw removed.

FIG. 35d is the side view of the support member of the embodiment ofFIG. 35a showing the upper and lower projections.

FIG. 35e is a perspective view of the upper jaw of the embodiment ofFIG. 35 a.

FIG. 35f is a top view of an alternative to the embodiment of FIG. 35ain a delivery configuration in which the upper and lower protrusions aremoved away from the centerline of the support member.

FIG. 36a is an alternative embodiment of a lysing tip comprising twoouter protrusions extending from a support member and two inner beadspositioned along a lysing member.

FIG. 36b is an upper plan view of various components of the lysing tipof the embodiment depicted in FIG. 36 a.

FIG. 36c is an upper plan view of the lysing tip of the embodimentdepicted in FIG. 36 a.

FIG. 36d is an upper plan view of certain components of the lysing tipof the embodiment depicted in FIG. 36 a.

FIG. 36e is a side view of the embodiment depicted in FIG. 36 a.

FIG. 37a is an alternative embodiment of a lysing tip comprising twobeads that may cover the end tips of the support member.

FIG. 37b is an upper plan view of certain components of the lysing tipof the embodiment depicted in FIG. 37 a.

FIG. 37c is an upper plan view of the lysing tip of the embodimentdepicted in FIG. 37 a.

FIG. 37d is a side view of the side bead of the embodiment depicted inFIG. 37a , said view being from the inside.

FIG. 37e is a side view of the side bead of the embodiment depicted inFIG. 37a , said view being from the outside.

FIG. 38a is an upper view of a lysing member with associated beads.

FIG. 38b is an exploded upper view of an alternative embodiment to thelysing tip of FIG. 38a in proximity to its modular grasping/controldevice.

FIG. 38c is an upper view of the embodiment of FIG. 38b in the deliveryconfiguration.

FIG. 39a is a perspective view of an embodiment comprising a modular tipfurther comprising a support member that slides through a slot withinsaid modular tip.

FIG. 39b is an upper view of the embodiment depicted in FIG. 39a in thetreatment configuration.

FIG. 39c is an upper view of a midline cross section of the embodimentdepicted in FIG. 39b in the treatment configuration comprising a pistonengaging and bracing the support member.

FIG. 39d is an upper view of the embodiment depicted in FIG. 39a in thedelivery configuration depicting an alternative mechanism to brace thesupport member during a surgical procedure.

FIG. 39e is an upper view of the embodiment depicted in FIG. 39a in thedelivery configuration depicting an alternative mechanism to fix thesupport member during a surgical procedure.

FIG. 40 is a flow chart illustrating one implementation of a method foran energy feedback loop.

FIG. 41 is a flow chart illustrating one implementation of a method forseparating and modifying tissues.

FIG. 42 is a flow chart illustrating one implementation of a method foraccessing an organ.

FIG. 43 is a flow chart illustrating one implementation of a method forhernia repair.

FIG. 44 is a flow chart illustrating one implementation of a method foraccessing the central nervous system.

FIG. 45 is a flow chart illustrating one implementation of a method forremoving tissue from a peripheral nerve.

FIG. 46 is a flow chart illustrating one implementation of a method forcreating a flap.

FIG. 47 is a flow chart illustrating one implementation of a method forcreating a graft.

FIG. 48 is a flow chart illustrating one implementation of a method forremoving tissue/tumor from an organ.

FIG. 49 is a flow chart illustrating one implementation of a method forremoving an organ.

FIG. 50 is a flow chart illustrating one implementation of a method forremoving scar and/or fibrotic tissue.

FIG. 51 is a flow chart illustrating one implementation of a method fortreatment of apocrine glands.

FIG. 52 is a flow chart illustrating one implementation of a method fortreatment of eccrine glands.

FIG. 53 is a flow chart illustrating one implementation of a method forreduction of hair.

FIG. 54a is a perspective view of surgical site involving cellulitetreatment.

FIG. 54b is a perspective view of surgical site involving cellulitetreatment.

FIG. 55 is a flow chart illustrating one implementation of a method fortreatment of cellulite.

FIG. 56 is a flow chart illustrating one implementation of a method forface dissection and/or face lifting.

FIG. 57 is a flow chart illustrating one implementation of a method forneck dissection and/or neck lifting.

FIG. 58 is a flow chart illustrating one implementation of a method fordissection of the brow and/or brow lifting.

FIG. 59 is a flow chart illustrating one implementation of a method forcreating pockets for implants.

FIG. 60 is a flow chart illustrating one implementation of a method forcapsulotomy.

FIG. 61 is a flow chart illustrating one implementation of a method forbody lifting and skin excision.

DETAILED DESCRIPTION

Further details regarding various embodiments will now be provided withreference to the drawings.

FIGS. 1a-j depict an embodiment of a CDTD 100 comprising a plurality ofprotrusions 101 and recessions 102 positioned in between adjacentprotrusions. In the depicted embodiment, recessions 102 comprise lysingsegments 103 a, 103 b, and 103 c. Thus, a lysing segment is positionedin each of the recessions 102 positioned in-between adjacent protrusions101. In the depicted embodiment, these three lysing segments 103 a, 103b, and 103 c are collectively defined by a lysing member 103. However,other embodiments are contemplated in which separate lysing members maybe used for each of the lysing segments positioned between adjacentprotrusions.

In this embodiment, the lysing member 103 comprises a lysing plate.However, other embodiments are contemplated in which separate lysingmembers may be used for each of the lysing segments 103 a/103 b/103 cpositioned between adjacent protrusions 101.

In the depicted embodiment, the cannulas 131 and 132 may comprise hollowtubes, which may comprise insulating and/or supportive coating(s) and/orcover overlying other conductive materials. The first/inner/devicecannula 131 may be considered a device cannula that is coupled withdevice/lysing tip 110 and may or may not be used with a second/outercannula. The second/outer cannula 132 could be associated with a trocarand may be used primarily for surgical introduction offirst/inner/device cannula 131 into body. In alternative embodiments andimplementations even first/inner/device cannula 131 may be omitted forcertain procedures. With respect to such embodiments, other structuralelements may be added to provide rigidity and/or to assist with deliveryand/or use of the device during a procedure.

It should be understood that in some embodiments or implementations,such devices can be used in connection with only a single cannula asshown in FIG. 1j . Such an embodiment or implementation may be usefulbecause: (A) the surgeon may not be working in a closed cavity thatrequires insufflation (for example, skin, fat, muscle); (B) it may allowthe manufacture of a larger tip configuration than the smallestcannula's constraining dimensions allowing for larger, thicker, strongercomponents than would otherwise be permitted to fit in the smallervolume or pass through a smaller cross-sectional area, or (C) it mayallow smaller diameter entrance incision/wound as cannulas have athickness component.

Each of the protrusions 101 extends from a common base 105 such that theprotrusions 101 are coupled with one another. In some embodiments, eachof the protrusions 101 is integrally coupled with each of the otherprotrusions 101. Thus, in some embodiments, each of the protrusions maybe defined by base 105. Alternatively, separate protrusions 101 may becoupled with or formed on base 105. A linking member 115 may be anintegral part of or a monolithic component with lysing member 103.Alternatively, linking member 115 could be coupled to the lysing member103. Linking member 115 may be used to facilitate a desired couplingbetween lysing tip 110—which, in the embodiment of FIG. 1e , comprisesprotrusions 101, recessions 102, lysing member(s) 103 (which maycomprised of lysing segments 103 a/103 b/103 c), linking member 115, andhinges 116/117 that may adhered to or otherwise coupled with linkingmember 115—and one or more elements used to facilitate delivery and/ordeployment of lysing tip 110 through cannulas 131 and/or 132 such asactuation rods 121, 122, 123, and/or 124. In some embodiments, linkingmember 115 may be a separate component from lysing tip 110 and may beused to couple lysing tip 110 to a hinge and/or actuation rod. Linkingmember 115 preferably is at least partially covered and in someembodiments fully covered by an insulating material so that theelectrosurgical energy is delivered to lysing segment 103 withoutdelivering electrosurgical energy to the rear of lysing tip 110. Inalternative embodiments, a wire or wires may extend through an insulatoror insulating portion of linking member 115 and connect with aconducting portion of linking member 115 and/or lysing member 103. Thiswire or wires could extend through or along one or both of the actuationrods and/or within the first/inner/device cannula 131 to supplyelectrosurgical energy to linking member 115 from the hand assembly.

In some embodiments and implementations, linking member 115 may benon-conductive and as such hinges 116 and 117 may be electricallycoupled to lysing member 103. Alternatively, hinges 116 and 117 may benon-conductive as well, and in such case, the lysing member 115 may beelectrically coupled to electrosurgical energy source by other meanssuch as wire for example.

Retraction guide 125 is preferably near tip 110 at or near the distalend of one of actuation rods 121/122. In the depicted embodiment,retraction guide 125 is positioned near the distal end of actuation rod122 adjacent to (immediately proximal of) tip 110. In some embodiments,retraction guide 125 may comprise a resilient material, such as aspring, so that it provides a restorative force during retraction of tip110 into cannula 131. Preferably, retraction guide 125 is positioned andconfigured so as to extend from actuation rod 122 laterally by adistance at least approximately equal to, in some embodiments slightlygreater than, the distance one or more of the protrusions 101 thatextend laterally relative to actuation rod 122 in the retracted/foldedconfiguration. In some embodiments, retraction guide 125 may extend inthis direction a distance equal to, or slightly greater than, thelargest protrusion 101 (in embodiments in which each of the protrusionsare not identical and/or do not project an equal distance).

In the depicted embodiment, protrusions 101 are fixed with respect tobase 105 and the rest of lysing tip 110. In this embodiment, protrusions101 are fixed three-dimensionally with respect to base 105 and the restof lysing tip 110. In other embodiments discussed later, protrusions 101may not be coupled to a common base. Similarly, in other embodimentsdiscussed later, protrusions 101 may be movable rather than fixedthree-dimensionally. For example, in some embodiments, protrusions 101may be rotatable with respect to a lysing member, a base, and/or anotherportion of lysing tip 110.

System 100 may be configured to allow for repositioning of lysing tip110 between a delivery configuration and a treatment configuration. Inthe delivery configuration, protrusions 101 may be configured to extendin a direction that is at least substantially perpendicular to thecannula axis, and lysing tip 110 may be configured to extend in adirection that is at least substantially parallel to the cannula axis.In other embodiments, lysing tip 110 may be configured to extend at anacute angle relative to the cannula axis so long as the axis of lysingtip 110 fits within the lumen of the cannula such as shown in FIG. 11fas an example. In addition, in the depicted embodiment, lysing tip 110may be configured such that an energy delivery side of lysing tip 110 infront of protrusions 101 and recessions 102, which energy delivery sidewill ultimately deliver electrosurgical energy for dissecting tissue,faces an interior surface of a lumen of first/inner/device cannula 131through which lysing tip 110 is delivered. Following delivery of lysingtip 110 through a distal end of first/inner/device cannula 131 and/orsecond/outer cannula 132, system 100 may be configured to repositionlysing tip 110 to the treatment configuration in which the energydelivery side extends at least substantially perpendicular to thecannula axis.

Lysing tip 110 may comprise an orientational-deployment side oppositefrom the energy delivery side. The orientational-deployment side oflysing tip 110 may be configured to allow lysing tip 110 to berepositioned between the delivery configuration and the treatmentconfiguration described above. A deployment assembly may be coupled withthe orientational-deployment side of lysing tip 110. This deploymentassembly may be configured to allow for selective repositioning betweenthe delivery and treatment configurations. In the depicted embodiment,the deployment assembly may comprise linking member 115 and one or morepivot members, such as pivot members 116 and 117. Pivot members 116and/or 117 may comprise various elements configured to allow forselective pivoting, rotation, and/or angulation of lysing tip 110, suchas joints, ball pivots, hinges, pins, groove/slot pairs, etc.

Pivot members 116 and 117 may be coupled with linking member 115 at oneend and may be coupled with distal (to the surgeon) portions 121 and 122of actuation rods, respectively. Thus, upon advancing one or both ofproximal actuation rods 123 and 124, lysing tip 110 may be advanced inits delivery configuration down one or more cannulas, such asfirst/inner/device cannula 131 and/or second/outer cannula 132. In someembodiments, appropriate wires or other transmission lines for deliveryof electrosurgical energy may be positioned to extend adjacent and/orthrough one or more of the various actuation rods. Alternatively, insome embodiments, electrosurgical energy may be delivered directlythrough one or more actuation rods. In some embodiments, wires or othertransmission lines for delivery of electrosurgical energy may instead,or additionally, extend though other regions of lumens offirst/inner/device cannula 131 and/or second/outer cannula 132.Actuation rods 121, 122, 123 and/or 124 may comprise any suitablematerial depending on whether electrosurgical energy is being deliveredthrough them. For example, a metal or other conductive material may beused if electrosurgical energy is to be delivered through the actuationrods, or a plastic or other insulating material may be used ifelectrosurgical energy is to be delivered through separate wiring orother suitable transmission lines. Actuation rods may be divided intomore segments, with or without pivots, than proximal or distal, forexample, 3 segments. In some embodiments, actuation rods may beinsulated with a non-conductive material but may have a conductive corefor delivery of electrosurgical energy.

In this embodiment, spot coagulator (“SC”) is comprised of SC shaft 141and SC tip 142 may be seen in the deployed view. SC Shaft 141 may becomprised of a metal insulated with a non-conductor. In the depictedembodiment, SC shaft 142 is slidably coupled to the first/inner/devicecannula 131. The more distal end of the SC is the SC tip 141 and themore proximal (toward the surgeon) end of the SC is SC shaft 142. Inthis depicted embodiment the SC tip 141 extends from the SC shaft 142and is conductive and not insulated along at least a portion of the tip.In some embodiments, the entire tip may be conductive. A spot coagulatormay be helpful by allowing the surgeon not to exchange other instrumentsduring the operative procedure to stem bleeding blood vessel(s); it maybe beneficial during some surgical procedures to have spot coagulatorcoagulation capabilities within the same instrument. In the depictedembodiment the SC tip 141 may be restricted to 25 mm protrusion beyondthe distalmost portion of lysing tip 110, which may comprise one end ofthe protrusions 101 on lysing tip 110. In various contemplatedembodiments, a bend in the SC shaft 142 and/or size mismatch and/ortether, etc., may also be used to limit the distance SC tip 141 mayprotrude. In other contemplated embodiments, no elements may restrictthe working movement range of the SC shaft 142. The SC shaft 142 mayderive its electrical energy from separate wiring and/or parasitizationoff of one or more of the actuation rods. In the depicted embodiment, SCshaft 142 may comprise one or more non-insulated area(s) that may bebrought into an actuation rod or other energetic source within thefirst/inner/device cannula 131. An implementation using the depictedembodiment may involve pushing distally SC either directly or indirectlyon the SC shaft 142 distally (possibly via through handle assembly 160).Electrosurgical energy, such as suitable electrosurgical waveform, maybe delivered when the electrosurgical generator is activated, via thehandle assembly 160 into the SC shaft 142 and thereupon to SC tip 141and then into target tissue. In the depicted embodiment SC shaft 142 maycomprise stainless steel and may be round in cross-section. Also in thedepicted embodiment, the exterior of the SC shaft 142 may be insulated.The electrical insulator may comprise, for example, porcelain, ceramics,glass-ceramics, plastics, various halogenated carbon molecules,polytetrafluoroethylene, carbon, graphite, and graphite-fiberglasscomposites and the like. In some embodiments, the conductive materialmay comprise: steel, nickel, alloys, palladium, gold, tungsten, silver,copper, platinum and/or any other conductive metal that does not giveoff toxic residua at operating temperatures. In other contemplatedembodiments, the conductive material may comprise cermets and the like.In the depicted embodiment, SC tip 141 is shaped like a sphere. In otherembodiments, the SC tip may be shaped like the frustum of a cone,pyramid, polyhedron, ellipsoid, as well as a wide variety of geometricshapes. In some embodiments, SC shaft 142 may be oval, flat, rectangularor geometric in cross-section or substantially flattened. In alternativeembodiments, SC tip 141 may be pointed, bullet shaped, or geometric incross section; more angulate and/or pointed tips may disperse electricalenergy more readily and allow greater precision than larger, morerounded tip designs. In the depicted embodiments of the SC shaft 142,the electrical insulator may comprise polytetrafluoroethylene. Inalternative embodiments the electrical insulator may comprise, forexample, polyether etherketone and/or polysulfone and/or anotherelectrically nonconductive polymers (with thermal stability in theoperating range) and/or materials that are both electricallynon-conductive and of low thermal conductivity. In contemplatedembodiments the electrical insulator may comprise, for example,porcelain, ceramics, glass-ceramics, plastics, various halogenatedcarbon molecules, polytetrafluoroethylene, carbon, graphite, andgraphite-fiberglass composites and the like. Although the depictedembodiment shows a manually deployed SC, other contemplated embodimentsmay allow deployment to be (including but not limited to): motorizedand/or spring activated and/or screw driven and/or ratchet style and/orcog style and/or pneumatic and/or hydraulic, etc. In the depictedembodiment, the SC tip 141 and SC shaft 142 together may measure about,2 mm in diameter and be of a suitable length to match the given systemincluding the handle assembly. In some embodiments, the insulationthickness may range from about 0.1 mm to 3 mm. Embodiments arecontemplated wherein sizes of about one-fifth to about five times thesedimensions may have possible uses. It is also contemplated in someveterinary embodiments tip sizes of about one-tenth to 20 times theaforementioned dimensions having possible uses.

System 100 comprises two separate cannulas, namely, a first/inner/devicecannula 131 which preferably comprises a lumen of sufficient diameter toallow folded lysing tip 110 (in a delivery configuration) to bepositioned within the lumen of first/inner/device cannula 131, and asecond second/outer cannula 132, which may have a larger cross-sectionaldiameter; the first/inner/device cannula 131 may be delivered withinsecond/outer cannula 132.

In some embodiments and implementations, lysing tip 110 may beconfigured such that its protrusions 101 and/or another portion oflysing tip 110 are too large to fit within the lumen offirst/inner/device cannula 131, even in the delivery configuration.Thus, lysing tip 110 in its delivery configuration may be positionedjust outside (immediately distal) of second cannula 132 and withinfirst/inner/device cannula 131 during delivery and retraction. Any ofthe embodiments described herein may be configured such that the tip 110cannot be fully received within first/inner/device cannula 131. Thisembodiment may be useful because it permits the tip to be as large aspossible given the dimension constraints of the second/outer cannula andnot the first/inner/device cannula thus reducing the expense of furtherminiaturizing and/or allows for thicker/stronger components.

By providing two co-axial cannulas, proximal actuation rods 123 and 124may be prevented, or at least substantially prevented, from inordinatebending and/or being separated from one another or otherwise system 100may be configured to maintain better control over lysing tip 110 duringdeployment. Thus, preferably, actuation rods 123 and 124 are alsodelivered through first/inner/device cannula 131. Some embodiments mayfurther comprise one or more additional joints and/or pivot memberspositioned proximally relative to pivot members 116 and 117. Forexample, some such embodiments may comprise hinges and/or pivot membersthat are positioned within one or both of proximal actuation rods123/124, and one or both distal actuation rods 121/122 such as hinges127 and 128. Hinges 127/128 may allow for one or both of distalactuation rods 121/122 to be pivoted/rotated in a desired direction oncehinges 127/128 have exited or are approximately coincident with or nearthe terminal end of first/inner/device cannula 131.

In the depicted embodiment, hinge 127 may be actuated by providingactuating means comprising two cords 129 a and 129 b that extend fromactuation rod 121. Cords 129 a and 129 b may be coupled with lysing tip110 such that forces from cords 129 a and 129 b may be transferred tolysing tip 110 to result in pivoting of hinge 127. By selectivelypulling on one of the cords 129 a and 129 b, tip 110 may be rotated in adesired direction and by selectively pulling on another of the cords 129a and 129 b, tip 110 may be rotated in a different desired direction. Ofcourse, any number of cords may be used to fine tune the pivotability oflysing tip 110 as desired. Cords 129 a and 129 b may comprise anysuitable material, such as wiring, plastic, metal, string, biopolymer,etc. Cord attachment areas 121 u and 121L on distal actuation rod 121may be used to affix cords 129 a and 129 b. Such cord attachment areasmay comprise an opening for insertion of the cord which may include aplug or weld to secure the cord. In other embodiments, the cordattachment area 121 u or 121L may comprise a weld against the surface ofdistal actuation rod 121.

The deployment assembly of system 100 may further comprise a handleassembly 160 that may be used to selectively deploy lysing tip 110 andcontrol various aspects of its delivery and/or use during surgery.Handle assembly 160 comprises a body 161 coupled with a pistol grip 162.First/inner/device cannula 131 may extend from and be coupled withhandle assembly 160. A rocker assembly 165 or another such control meansmay be provided for actuation of various features/functions/elements insystem 100. For example, rocker assembly 165 may be coupled with cords126 a/126 b and 129 a/129 b such that, upon pressing rocker assembly 165along a top portion of the assembly, a first cord or set of cords 126 band 129 b may be pulled causing the tip 110 to rotate upwards.Similarly, rocker assembly 165 may be further configured such that, uponpressing rocker assembly 165 along a bottom portion of the assembly theother cord or set of cords 126 a and 129 a may be pulled causing the tipto rotate downwards. Upon pushing one of cords 126 a/129 a, the other ofcords 126 b/129 b may be moved in an opposite direction, since pushingone end of rocker assembly 165 may result in an opposite movement of theopposite end of rocker assembly 165. In this manner, lysing tip 110 maybe selectively moved in one direction or another as desired. In analternative embodiment, a more rigid cord or wire may be used to push anactuation rod into a desired position.

In this particular embodiment, hinges 127 and 128 may be positionedbetween or at the ends of actuation rods 121/123 and/or 122/124,respectively, and may allow for rotation of lysing tip 110 above and/orbelow the cross-sectional profile of first/inner/device cannula 131.Alternatively, hinges 127 and 128 or other means for facilitatingmovement of the tip outside of the cross-sectional profile of thefirst/inner/device cannula 131 may be positioned along the length of oneor more actuation rods such as 123 or 124 in which case distal actuationrods may be omitted.

An electrosurgical actuation button 167 may be provided, which a surgeonmay use to initiate transmission of electrosurgical energy to lysing tip110. More particularly, electrosurgical actuation button 167 may be usedto initiate transmission of electrosurgical cutting or blended energy tolysing member/plate 103. Button 167 may be positioned on rocker assembly165 if desired, as shown in FIG. 1i . Pressing or otherwise actuation ofbutton 167 may result in delivery of such energy from an electrosurgicalgenerator coupled with handle assembly 160. Handle assembly 160 may alsobe used in connection with any of the other embodiments disclosedherein.

Lysing member 103 is shown removed from the rest of lysing tip 110 inFIGS. 1g and 1h . As shown in FIG. 1h , lysing member 103 may beconfigured to define three separate lysing segments, as shown in thefigure. In other embodiments, however, lysing member 103 may beseparated into three distinct and separated segments. This may be usefulfor certain applications, such as, for example, for embodiments usingbipolar electrosurgical energy, such that each separate segment may beactivated with electrosurgical energy separately.

Handle assembly 160 may further comprise one or more other actuationcontrols. For example, as also shown in FIG. 1i , handle assembly 160may comprise a first actuation rod control 168 and a second actuationrod control 169. In some embodiments, one or both of first and secondactuation rod controls 168 and 169 may comprise a ratchet to allow asurgeon to more precisely control the distance with which lysing tip 110is extended and/or allow for locking lysing tip 110 in place withrespect to first/inner/device cannula 131 and/or second/outer cannula132. In some embodiments, one or both of first and second actuation rodcontrols 168 and 169 may have a manual control element, such as a fingercontrol element as shown, or another grip, button, trigger, or othersuitable control element. First and second actuation rod controls168/169 may be directly or indirectly connected to proximal actuationrods 123/124 to effect movement and positioning of lysing tip 110.

In some embodiments, handle assembly 160 may be configured to berotatable with respect to the first/inner/device cannula 131 and/or thesecond/outer cannula 132 such that the lysing tip 110 may be selectivelyrotated within a patient's body. In other words, system 100 may beconfigured such that some or all of the elements of the system otherthan first/inner/device cannula 131 and/or second/outer cannula 132, orin some embodiments some or all elements within first/inner/devicecannula 131 and/or second/outer cannula 132 (such as, in someembodiments, just lysing tip 110), may be selectively rotated fromhandle assembly 160 to allow lysing tip 110 to be selectively rotated asneeded during surgery.

It should be understood that handle assembly 160 may be used inconnection with one or more of the other systems disclosed herein. Ofcourse, those of ordinary skill in the art will appreciate that anyother handle assembly, gun, or other available control mechanism mayalso be used, as desired.

Some embodiments may be configured such that lysing tip 110 is notaligned with the axis of cannulas 131 or 132 in the deliveryconfiguration. More particularly the axis of lysing tip 110 may bepositioned at an acute angle with respect to the axis of cannulas 131 or132. In other embodiments, lysing tip 110 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 110 fits within the lumen and/or lumens of one and/or bothcannulas.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 131 may vary as for example,as shown in FIGS. 14k and 14L. In other words, the lysing tip 110 in theaxial deployment configuration may be unable to be received withincannula 131 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula of two delivery cannulas as shown in FIG. 14k .In embodiments comprising two cannulas, this may be useful because ifthe lysing tip does not require substantial protection and can remainoutside the inner cannula's lumen, then the critical dimensions of thelysing tip can correspond to the larger diameter outer cannula asopposed to being limited to the smaller dimensions of the inner/devicecannula. In embodiments comprising a single cannula, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip in its axial/delivery configuration onlyneed to correspond to the size of the entrance incision. With respect tosuch embodiments, the single cannula may primarily serve to protect andstabilize the control rods and provide rigidity to the assembly. Suchembodiments may be useful for cosmetic procedures within the skin, forexample, but not limited to, for face lifting and/or cellulitetreatment.

Although in the embodiments previously depicted, the protrusionstypically extended along an axis of the cannula and were parallel to oneanother along the lysing tip, other embodiments are contemplated inwhich non-axial protrusions may instead be provided. In some suchembodiments such as those depicted in FIGS. 26a /26 b, for example, thetwo outermost protrusions/beads may extend at an angle of between about60 degree and 90 degrees relative to each other. In some embodiments,adjacent beads/protrusions may be configured to extend relative to eachother at an angle between about 20 to 40 degrees. It is contemplatedthat it may be desirable for some implementations and embodiments toprovide, non-axial tips extending in a direction or directions fallingwithin this range in order to, for example, allow a surgeon toeffectively perform both a to and fro, and a side-to-side (“windshieldwiper”) motion using the CDTD. Such side or non-axial protrusions may beuseful to enable a surgeon to avoid entangling the dissector in tissueduring one or both such motions.

FIGS. 2a-2e depict an alternative embodiment of a CDTD system 200comprising a plurality of protrusions 201 and recessions 202 positionedin between adjacent protrusions. In the depicted embodiment, a lysingmember 203 (comprised of lysing segments 203 a/203 b/203 c) ispositioned so as to extend in recessions 202 and define a plurality oflysing segments. Thus, a lysing segment 203 a/203 b/203 c is positionedin each of the recessions 202 positioned in-between adjacent protrusions201. Lysing member 203 is further electrically coupled to linking member215. System 200 further comprises first/inner/device cannula 231 andsecond/outer cannula 232, the first or both which may be used to deliverlysing tip 210, as previously mentioned.

Some embodiments may comprise an energy window 211 located proximally toprotrusions 201. In the depicted embodiment, energy window system 206may comprise electrode termini 206 a/206 b/206 c/206 d which may besupplied energy from an energy source via conduits (not shown) that maycomprise, for example, wires and/or fiber optic filaments and/or thelike. Energy window 206 may be configured in any manner to accommodateany energy modality, including, but not limited to, laser, intense pulselight, resistive heating, radiant heat, thermochromic, ultrasound,mechanical, and/or microwave.

In some embodiments, each of the various electrode termini 206 a/b/c/dmay comprise separate elements each of which may be coupled with lysingtip 210. In such embodiments, it may be preferred to have an electricalconduit such as a wire coupled along tip 210 between each adjacenttermini 206 a/b/c/d. Alternatively, a ribbon and/or band or othersuitable coupling element (not shown) may define or contain each of thevarious termini. Such coupling elements may be coupled with lysing tip210 in any suitable manner.

System 200 only differs from system 100 in that it lacks a spotcoagulator and possesses an energy window(s).

FIGS. 3a-3e depict another alternative embodiment of a CDTD system 300comprising a plurality of protrusions 301 and recessions 302 positionedin between adjacent protrusions 301. In the depicted embodiment, alysing member 303, and its associated lysing segments 303 a/303 b/303 c,is positioned so as to extend in recessions 302 and define a pluralityof lysing segments. Thus, a lysing segment is positioned in each of therecessions 302 positioned in-between adjacent protrusions 301. System300 further comprises first/inner/device cannula 331 and may comprisesecond/outer cannula 332, which may be used to deliver lysing tip 310,as previously mentioned.

System 300 only differs from system 100 in that it possessesunitary/unhinged actuation rods, a canal, and rotational stop means andthat system 300 lacks a spot coagulator.

System 300 may comprise canal(s) 304 which may be positioned to supplyone or more fluids to the surgical site around or near lysing tip 310via a port located adjacent to the internal device cannula and/or lysingtip (show in FIG. 3a only). Canal 304 may be configured to be extendedand withdrawn as needed. In alternative embodiments, other fluids thatmay pass down canal 304 may include, but not be limited to, coldnitrogen gas, fluorocarbons, etc., which might cool and/or freeze tissueto alter it in a desired fashion.

Most notably, system 300 comprises means for fixing the rotationalorientation of lysing tip 310 with respect to first/inner/device cannula331. In some embodiments the rotational fixing means may also provideproximal support to lysing tip 310 during a surgical procedure. Moreparticularly, in the depicted embodiment, this rotational fixing meanscomprises opposing slots 333 a and 333 b formed in the distal end offirst/inner/device cannula 331, which slots are sized, shaped, andconfigured to receive at least a portion of actuation rods 323/324 whendeployed distally. Other examples of rotational fixing means 333 a/333 binclude hooks, catches, etc. In addition, in another example of arotational fixing means, corresponding features on the deployment sideof lysing tip 310 may engage the distal end or special features designedin the distal end of first/inner/device cannula 331. In someembodiments, such fixing may also provide direct support restrictingproximal movement. In alternative embodiments, rotational fixing meansmay comprise grooves on the inside of the cannula lumen of raised railsor channels in the material from which cannulas are made; said groovesengage one or both actuation rods for support.

FIG. 3d shows how portions of the actuation rods 323/324 engagerotational fixing means 333 a/333 b.

FIG. 3a is an isometric view depicting how, in the treatmentconfiguration, lysing tip 310 extends, at both opposing ends, beyond thecross-sectional profile of first/inner/device cannula 331. Also, in thisparticular embodiment, lysing tip 310 is coupled with actuation rods323/324 at points that are greater than the inner diameter of thecross-sectional profile of first/inner/device cannula 331 in thetreatment configuration.

Retraction guide 325 is preferably near tip 310 at or near the distalend of one of actuation rods 323/324. In the depicted embodiment,retraction guide 325 is positioned near the distal end of actuation rod324 adjacent to (immediately proximal of) lysing tip 310. In someembodiments, retraction guide 325 may comprise a spring and/or be madeup of a resilient material so that it provides a restorative forceduring retraction of lysing tip 310 into first/inner/device cannula 331.Preferably retraction guide 325 may be shaped to (A) if made of anon-resilient material, have a sufficient slope so that the edge closestto the cannula does not have its proximal movement impeded but rathercause a lateral movement of the actuation rods and tip toward theopposite side of the cannula or (B) if made of a resilient material,upon contacting the distal end of the cannula, retraction guide 325deforms in a manner that permits proximal movement and then provides arestorative force that guides the lateral movement of the actuation rodsand tip to the opposite side of the cannula. Preferably, retractionguide 325 is positioned and configured so as to extend from actuationrod 324 laterally by a distance at least approximately equal to, in someembodiments slightly greater than, the distance one or more of theprotrusions 301 that extend laterally relative to actuation rod 324 inthe retracted/folded configuration. In some embodiments, retractionguide 325 may extend in this direction a distance equal to, or slightlygreater than, the largest protrusion 301 (in embodiments in which eachof the protrusions are not identical and/or do not project an equaldistance).

In the depicted embodiment, each of the protrusions 301 extends from acommon base 305 such that the protrusions 301 are coupled with oneanother. In some embodiments, each of the protrusions 301 is integrallycoupled with each of the other protrusions 301. Linking member 315 maybe coupled to base 305 and/or lysing member 303.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 331 may vary as for example,as shown in FIGS. 14k and 14L. In other words, the lysing tip 310 in theaxial deployment configuration may be unable to be received withincannula 331 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula of two delivery cannulas as shown in FIG. 14k .In embodiments comprising two cannulas, this may be useful because ifthe lysing tip does not require substantial protection and can remainoutside the inner cannula's lumen, then the critical dimensions of thelysing tip can correspond to the larger diameter outer cannula asopposed to being limited to the smaller dimensions of the inner/devicecannula. In embodiments comprising a single cannula, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip in its axial/delivery configuration onlyneed to correspond to the size of the entrance incision required for acertain procedure. For example, plastic surgeons may usually attempt tominimize scarring with minimum entrance incision widths, thus, intreating cellulite, the width of the entrance incision and lysing tipprofile using embodiments contemplated herein may be 3 to 6 mm. Withrespect to such embodiments, the single cannula may primarily serve toprotect and stabilize the control rods and provide rigidity to theassembly. Such embodiments may be useful for cosmetic procedures withinthe skin, for example, but not limited to, for face lifting and/orcellulite treatment.

In the depicted embodiment, 347 represents an antenna configured todeliver a signal to a receiver unit. In some embodiments, antenna 347may comprise radiofrequency identification (RFID) TAG. In someembodiments the RFID tag may comprise an RFID transponder. In otherembodiments the RFID tag may comprise a passive tag. It should beunderstood that antenna 347 is not depicted in every one of the otherfigures; any of the embodiments described herein may comprise one ormore such elements. Other embodiments may comprise one or more antennaon any other suitable location on the embodiment, including but notlimited to on the protrusions or otherwise on the tip, and on the shaft.In embodiments in which antenna 347 comprises an RFID transponder, theRFID transponder may comprise a microchip, such as a microchip having arewritable memory. In some embodiments, the tag may measure less than afew millimeters. In some embodiments a reader may generate analternating electromagnetic field which activates the RFID transponderand data may be sent via frequency modulation. In an embodiment, theposition of the RFID tag or other antenna may be determined by analternating electromagnetic field in the ultra-high frequency range. Theposition may be related to a 3 dimensional mapping of the subject. In anembodiment the reader may generate an alternating electromagnetic field.In some such embodiments, the alternating electromagnetic field may bein the shortwave (13.56 MHz) or UHF (865-869 MHz) frequency. Examples ofpotentially useful systems and methods for mapping/tracking a surgicalinstrument in relation to a patient's body may be found in U.S. PatentApplication Publication No. 2007/0225550 titled “System and Method for3-D Tracking of Surgical Instrument in Relation to Patient Body”, whichis hereby incorporated by reference in its entirety.

In some embodiments, a transmission unit may be provided that maygenerate a high-frequency electromagnetic field configured to bereceived by an antenna of the RFID tag or another antenna. The antennamay be configured to create an inductive current from theelectromagnetic field. This current may activate a circuit of the tag,which may result in transmission of electromagnetic radiation from thetag. In some embodiments, this may be accomplished by modulation of thefield created by the transmission unit. The frequency of theelectromagnetic radiation emitted by the tag may be distinct from theradiation emitted from the transmission unit. In this manner, it may bepossible to identify and distinguish the two signals. In someembodiments, the frequency of the signal from the tag may lie within arange of the frequency of the radiation emitted from the transmissionunit. Additional details regarding RFID technology that may be useful inconnection with one or more embodiments discussed herein may be foundin, for example, U.S. Patent Application Publication No. 2009/0281419titled “System for Determining the Position of a Medical Instrument,”the entire contents of which are incorporated herein by specificreference.

In other embodiments, antenna 347 may comprise a Bluetooth antenna. Insuch embodiments, multiple corresponding Bluetooth receivers at knownlocations may be configured to sense signal strengths from the Bluetoothantenna 347 and triangulate such data in order to localize the signalfrom the Bluetooth antenna 347 and thereby locate the lysing tip withina patient's body. Other embodiments may be configured to useangle-based, electronic localization techniques and equipment in orderto locate the antenna 347. Some such embodiments may comprise use ofdirectional antennas, which may be useful to increase the accuracy ofthe localization. Still other embodiments may comprise use of othertypes of hardware and/or signals that may be useful for localization,such as WIFI and cellular signals, for example.

One or more receiver units may be set up to receive the signal from thetag. By evaluating, for example, the strength of the signal at variousreceiver units, the distances from the various receiver units may bedetermined. By so determining such distances, a precise location of thelysing tip relative to a patient and/or a particular organ or othersurgical site on the patient may be determined. In some embodiments, adisplay screen with appropriate software may be coupled with the RFID orother localization technology to allow a surgeon to visualize at leastan approximate location of the tag/antenna, and therefore the lysingtip, relative to the patient's body.

Some embodiments may be further configured such that data from theantenna(s) may be used in connection with sensor data from the device.For example, some embodiments comprising one or more sensors 348 may befurther configured with one or more RFID tags. As such, data from theone or more sensors may be paired or otherwise used in connection withdata from the one or more RFID tags or other antennas. For example, someembodiments may be configured to provide information to a surgeonregarding one or more locations on the body from which one or moresensor readings were obtained. In some embodiments, temperature sensorsmay include thermistors and/or thermocouples. To further illustrateusing another example, information regarding tissue temperature may becombined with a location from which such tissue temperature(s) weretaken. In this manner, a surgeon may be provided with specificinformation regarding which locations within a patient's body havealready been treated in an effective manner and thus which locationsneed not receive further treatment using the device.

In some such embodiments, a visual display may be provided comprising animage of the patient's body and/or one or more selected regions of apatient's body. Such a system may be configured so as to provide avisual indication for one or more regions within the image correspondingto regions of the patient's tissue that have been sufficiently treated.For example, a display of a patient's liver may change colors atlocations on the display that correspond with regions of the liver thathave experienced a sufficient degree of fibrosis or other treatment.Such regions may, in some embodiments, be configured such that pixelscorresponding to particular regions only light up after thecorresponding tissue in that region reaches a particular thresholdtemperature.

Such sensor 348 may be coupled with an antenna, which may send and/orreceive one or more signals to/from a processing unit. Alternatively, oradditionally, data from such sensors resulting from tissue and/or fluidanalysis using such sensors may be stored locally and transmitted later.As yet another alternative, such a signal may be transmitted followingsurgery. In such implementations, the signals need not necessarily betransmitted wirelessly. In fact, some embodiments may be configured tostore data locally, after which a data module, such as a memory stick,may be removed from the device and uploaded to a separate computer foranalysis.

Some embodiments may be configured such that lysing tip 310 is notaligned with the axis of cannulas 331 or 332 in the deliveryconfiguration. More particularly the axis of lysing tip 310 may bepositioned at an acute angle with respect to the axis of cannulas 331 or332. In other embodiments, lysing tip 310 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 310 fits within the lumen and/or lumens of one and/or bothcannulas.

FIGS. 4a-4h depict an alternative embodiment of a CDTD system 400comprising a plurality of protrusions 401 and recessions 402 positionedin between adjacent protrusions. In the depicted embodiment, a lysingmember 403, comprised of lysing segments 403 a/403 b, is positioned soas to extend in recessions 402 and define a plurality of lysingsegments. Thus, a lysing segment 403 a/403 b is positioned in each ofthe recessions 402 positioned in-between adjacent protrusions 401.System 400 further comprises first/inner/device cannula 431 andsecond/outer cannula 432, the first or both which may be used to deliverlysing tip 410, as previously mentioned.

System 400 differs from system 100 in that it lacks a spot coagulator,is configured for bipolar electrosurgical energy delivery, has 3protrusions and 2 lysing segments, and has electrically isolated linkingmembers 415 a/415 b.

An external power cord may bring electrosurgical energy from anelectrosurgical generator to a hand assembly 160, such as thatillustrated in FIG. 1i , (which is electrically connected) to proximalactuation rods 423/424 which are physically and electrically via contactcoupled to distal actuation rods 421/422 and thus to linking members 415a/415 b (via pivot members 416/417) and thus to their respectiveelectrically conductive lysing segments 403 a/403 b, mounted in therecessions 402 in between protrusions, such as protrusions 401. Forexample, electrosurgical current (comprised of alternating currentadjusted to perform certain functions) may flow from electrosurgicalgenerator via proximal actuation rod 423 to distal actuation rod 421 toits physically-connected/electrically-coupled/respective linking member415 a and thus to itsphysically-connected/electrically-coupled/respective electricallyconductive lysing segment 403 a. The electrosurgical current may thentravel into the adjacent/target tissue of the patient via lysing segment403 a and then back into lysing segment 403 b and may then return to theelectrosurgical generator via linking member 415 b via distal actuationrod 422 via proximal actuation rod 424. By virtue of the linking members415 a/415 b being separated and/or insulated from each other, thecurrent may not short circuit within lysing tip 410. Retraction guide425 is preferably near tip 410 at or near the distal end of one ofactuation rods 421/422.

The tip shown in this embodiment has three relative protrusions 401,lysing member 403 (and associated lysing segments 403 a/403 b, pointingalong the main axis of the CDTD in treatment mode. In other embodiments,the bipolar CDTD lysing tip 410 may have one or more non-axialprotrusions and one or more non-axial relative recessions. In someembodiments, the tip may have between 3 and 100 axial and/or non-axialprotrusions and/or relative recessions. It should be understood that thenumber of protrusions need not match the number of lysing elements orrecessions. In some embodiments, lysing elements may be located at thetermini of conductive elements. In some embodiments, lysing elements mayalso be made partially or completely of a cermet material. In anembodiment, the modular bipolar CDTD tip 410 may measure about 12 to 15mm in width and/or about 3 mm in thickness. Embodiments are contemplatedwherein sizes of about one-fifth to about five times these dimensionsmay have possible uses. It is also contemplated, for example in someveterinary embodiments, tip sizes of about one-tenth to 20 times theaforementioned dimensions may have possible uses. In some embodiments,wherein electrical insulation and/or polymeric insulating coating ispresent on such parts, for example, but not limited to, distal andproximal actuation rods and linking member portions 415 a/415 b, suchinsulation may measure about 0.5 mm in thickness; in some contemplatedembodiments, the insulation thickness may range from 0.01 mm to 3 mm. Inother contemplated embodiments, electroconductive leads may course froman electrosurgical generator via first/inner/device cannula 431 toenergize various lysing elements located in bipolar CDTD tip 410. Insome embodiments leads may comprise wires and/or conductive conduits.

FIG. 4g is a posterior elevated perspective view of the two bipolarlysing segments of the embodiment depicted in FIG. 4a . In thisembodiment, lysing element 403 may be comprised of even numbers ofoppositely charged (when activated) individual lysing segments 403 a/403b. In this embodiment, individual bipolar CDTD lysing segments 403 a/403b may comprise surgical grade stainless steel positioned within alland/or a portion of one or more pieces of ceramic and/or other thermallyresistant, non-conductive housing. In some embodiments, one or moreindividual lysing elements may comprise electroconductive materialsincluding but not limited to cermets, steel, nickel, alloys, palladium,gold, tungsten, titanium, silver, copper, and/or platinum. In thedepicted embodiment, the lysing elements may measure about 2 mm inlength, and about 0.5 mm in thickness/diameter. In the depictedembodiment, the axial lysing elements are concave and crescentic inshape. However, in other contemplated embodiments lysing elements maycomprise straight and/or convex and/or a variety of shapes.

In some contemplated embodiments there need not be equal numbers ofoppositely signed and/or charged individual lysing elements, forexample, there may be 3 positive and 2 negative individual lysingelements. Uniformity of flux on activation may be achieved by modifyingthe size and/or position of lysing elements with respect to each otheramong other methods known in the art.

The relative static permittivity of some ceramics may range from about 5to 10; this may cause some leakage of current in an undesirable pathbetween closely approximated opposing electrodes during activation. Useof other materials, for example, those having over of relative staticpermittivities of 5 may undesirably alter the resultant plasma field.The relative static permittivity of the intervening materials housingthe opposing electrodes may be enhanced by coating and/or surroundingand/or injection molding thermoresistant polymers of a low relativestatic permittivity into the housing and/or around one or more portionsof bipolar lysing segments 403 a/403 b to reduce the effective staticpermittivity of the tip. In an embodiment, the thermoresistant polymerof low relative static permittivity 2.1 may be polytetrafluoroethylene.In other contemplated embodiments, thermoresistant polymers may includepolyether etherketone (@3.3) and/or polysulfone (@3.1) and the like maybe useful.

In the depicted embodiments, the electrical insulator comprisespolytetrafluoroethylene. In other contemplated embodiments, theelectrical insulator may comprise an electrically nonconductive polymerwith a high melting temperature. In some embodiments, the nonconductivepolymer may comprise for example, polyether etherketone and/orpolysulfone, etc. In other contemplated embodiments, the electricalinsulator may comprise an electrically nonconductive and/or thermallynonconductive polymer.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 431 may vary as for example,as shown in FIGS. 14k and 14L. In other words, the lysing tip 410 in theaxial deployment configuration may be unable to be received withincannula 431 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula of two delivery cannulas as shown in FIG. 14k .In embodiments comprising two cannulas, this may be useful because ifthe lysing tip does not require substantial protection and can remainoutside the inner cannula's lumen, then the critical dimensions of thelysing tip can correspond to the larger diameter outer cannula asopposed to being limited to the smaller dimensions of the inner/devicecannula. In embodiments comprising a single cannula, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip in its axial/delivery configuration onlyneed to correspond to the size of the entrance incision. With respect tosuch embodiments, the single cannula may primarily serve to protect andstabilize the control rods and provide rigidity to the assembly. Suchembodiments may be useful for cosmetic procedures within the skin, forexample, but not limited to, for face lifting and/or cellulitetreatment.

As of the year 2000, the bipolar mode had traditionally been usedprimarily for coagulation (reference: “The Biomedical EngineeringHandbook, Electrosurgical Devices” J Eggleston, W Maltzahn, Ch 81, CRCPress 2000). However, more recent modifications to bipolarelectrosurgical outputs may have facilitated the use of bipolar cuttinginstruments (reference: ValleyLab, Hotline, vol. 4, issue 4 pg. 1),examples of such outputs may include Macrobipolar settings (Reference:ValleyLab ForceTriad Users Guide 2006, chapter/sections: 9-13, 9-16,9-24).

Some embodiments may be configured such that lysing tip 410 is notaligned with the axis of cannulas 431 or 432 in the deliveryconfiguration. More particularly the axis of lysing tip 410 may bepositioned at an acute angle with respect to the axis of cannulas 431 or432. In other embodiments, lysing tip 410 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 410 fits within the lumen and/or lumens of one and/or bothcannulas.

FIGS. 5a-5e depict still another embodiment of a CDTD system 500. FIG.5a depicts system 500 in a treatment configuration. System 500 againcomprises a plurality of protrusions 501 and recessions 502 positionedin between adjacent protrusions 501. In the depicted embodiment, alysing member 503, comprised of lysing segments 503 a/503 b/503 c, ispositioned so as to extend in recessions 502 and define a plurality oflysing segments. Thus, a lysing segment is positioned in each of therecessions 502 positioned in-between adjacent protrusions 501. System500 further comprises first/inner/device cannula 531 and second/outercannula 532, which may be used to deliver lysing tip 510 therethrough.

System 500 differs from those previously described in that system 500comprises an intermediate hinge member 522 that is pivotably coupled atone end 525 a to a first actuation rod 521 and pivotably coupled at theopposite end 525 b to lysing tip 510. More particularly, intermediatehinge member 522 is pivotably coupled 525 b at the opposite end to base505 via linking member 515. In addition, system 500 comprises a pivotmember 523 that is also coupled to lysing tip 510, but is coupled tolysing tip 510 at a mid-point of lysing tip 510 between its opposingends via linking member 515. Pivot member 523 may also be coupled toactuation rod 520.

FIG. 5c depicts system 500 in a delivery configuration with lysing tip510 folded up in alignment with the axis of first/inner/device cannula531 and/or second/outer cannula 532. FIG. 5b depicts another perspectiveview of system 500 in an interim position between the treatmentconfiguration and the delivery configuration that depicts the rear orproximal side of lysing tip 510. As better seen in this figure, the rearof lysing tip 510 comprises a common base 505 from which each of theprotrusions 501 extends. Lysing tip 510 again comprises a base 505coupled to linking member 515. In addition, it can be seen from FIG. 5bthat both intermediate hinge member 522 and pivot member 523 are coupledto lysing tip base 505 via linking member 515.

Some embodiments may be configured such that lysing tip 510 is notaligned with the axis of cannulas 531 or 532 in the deliveryconfiguration. More particularly the axis of lysing tip 510 may bepositioned at an acute angle with respect to the axis of cannulas 531 or532. In other embodiments, lysing tip 510 may be configured to extend atan acute angle relative to the cannula axis so long as the axis oflysing tip 510 fits within the lumen and/or lumens of one and/or bothcannulas.

FIGS. 6a-6e depict yet another alternative embodiment of a CDTD system600. FIG. 6a is a perspective view depicting system 600 in a treatmentconfiguration. System 600 again comprises a plurality of protrusions 601and recessions positioned in between adjacent protrusions 601. In thedepicted embodiment, a lysing member 603 is positioned so as to extendin the recessions and define a plurality of lysing segments 603 a/603b/603 c. Thus, a lysing segment is positioned in each of the recessionspositioned in-between adjacent protrusions 601. System 600 furthercomprises first/inner/device cannula 631 and/or second/outer cannula632, which may be used to deliver lysing tip 610 therethrough.

Although, like system 500, system 600 comprises an intermediate hingemember 622, system 600 differs from system 500 in that system 600comprises an intermediate hinge member 622 that is pivotably coupled atone end 625 a to a first actuation rod 621 but is pivotably coupled atthe opposite end 625 b to a mid-point or near mid-point of lysing tip610 rather than adjacent to an end of lysing tip 610. More particularly,intermediate hinge member 622 is pivotably coupled to a mid-point ornear mid-point of base 605 via linking member 615. Pivot member 623 maybe coupled to actuation rod 620.

System 600 also differs from system 500 in that pivot member 623 iscoupled to an end of lysing tip 610 rather than to a mid-point of lysingtip 610 as in system 500. Because of these pivot/coupling points, lysingtip 610 only extends beyond the cross-sectional profile offirst/inner/device cannula 631 and/or second/outer cannula 632 at oneend (the end opposite from pivot member 623), as shown in FIG. 6 a.

FIG. 6c depicts system 600 in a delivery configuration with lysing tip610 folded up in alignment with the axis of first/inner/device cannula631. FIG. 6b better depicts the opposing hinges of intermediate hingemember 622, namely first hinge 625 a and opposite hinge 625 b.

FIGS. 7a-7f depict an alternative embodiment of a CDTD system 700.System 700 comprises a lysing tip 710 that is configured to becompletely separated from any other element of the system. In thismanner, lysing tip 710 may be delivered through one cannula 732 and thencoupled with a grasping/control instrument 790 (see FIG. 7f ) that maybe used to control the lysing tip 710 within the body of a patientduring a surgical procedure. In some embodiments and implementations, asecond cannula, positioned through the same incision or another incisionat another site on the patient's body, such as the cannula 1735 in FIGS.17f & 17 g, may be used to deliver a transfer grasping instrument, suchas transfer grasping instrument 1796 as depicted in FIGS. 17f and 17g ,that may be used to facilitate coupling of lysing tip 710 to thegrasping/control instrument 790, which grasping/control instrument 790may be delivered through the same cannula 732 through which the lysingtip 710 is delivered. Alternatively, the lysing tip 710 may be deliveredthough a second cannula along with a transfer grasping instrument usedto couple the lysing tip 710 to grasping/control instrument 790delivered through the first cannula 732, which grasping/controlinstrument 790 may be used to control lysing tip 710 and perform thesurgical procedure. In alternative embodiments, the transfer graspinginstrument may comprise at the distal end other means for grasping thelysing tip 710 such as a hook and/or magnet and/or glue.

Lysing tip 710 may comprise a plurality of protrusions comprising bulbs701. A lysing member 703 may be positioned in recessions 702 fordelivering electrosurgical energy. Each of the segments of lysing member703 may be considered lysing segments 703 a/703 b/703 c. In the depictedembodiment, each of the lysing segments is collectively defined by asingle lysing member 703. However, other embodiments are contemplated inwhich separate lysing members may be used for each of the lysingsegments positioned between adjacent protrusions.

It should be understood that in some embodiments or implementations,such systems 700 can be used in connection without any cannula as shownin FIG. 7f . Such an embodiment or implementation may be useful because:(A) the surgeon may not be working in a closed cavity that requiresinsufflation (for example, skin, fat, muscle); (B) it may allow themanufacture of a larger tip configuration than the smallest cannula'sconstraining dimensions allowing for larger, thicker, strongercomponents than would otherwise be permitted to fit in the smallervolume or pass through a smaller cross-sectional area, or (C) it mayallow smaller diameter entrance incision/wound as cannulas have athickness component.

Each of the protrusions 701 extends from a common base 705 such that theprotrusions 701 are coupled with one another. In some embodiments, eachof the protrusions 701 is integrally coupled with each of the otherprotrusions 701 along base 705. A linking member 715 may be coupled tobase 705 and/or lysing member 703. In this particular embodiment,linking member 715 comprises a grasping pad 718. The structure ofgrasping pad 718 preferably comprises a plate-like shape having opposingsurfaces that match or may be grooved to match the jaws ofgrasping/control instrument 790. In the depicted embodiment, thesurfaces are flat and define parallel planes. Grasping pad 718 may be anintegral part of linking member 715 or be a separate element coupledwith linking member 715. Grasping pad 718 may be used to facilitate adesired coupling between lysing tip 710—which comprises protrusions 701,recessions 702, lysing member(s) 703, and/or linking member 715 and agrasping/control instrument 790 used to control lysing tip 710 during asurgical procedure, which instrument may also be delivered throughcannula 732. Pad 718, in this embodiment, comprises hole 718 c (shown inFIG. 7e only) which may be used for an alternative means of grasping orotherwise holding the lysing tip 710 in position for grasping/controlinstrument 790 to grasp lysing tip 710. Such additional means mayinclude threading cord and/or suture and/or wire through the hole orotherwise hooking hole 718 c or the like. Additionally, hole 718 h(shown in FIG. 7d only) may be used to receive a projection 796 a (shownin FIG. 7f only) mounted on the tip of grasping/control instrument toensure a more stable coupling. In some embodiments, the surface of tab718 may be completely electrically insulated except where contact ismade with upper or lower jaw 793/794. In alternative embodiments, theentire surfaces of jaws 793/794 and the entire tab may be insulatedexcept within hole 718 h (shown in FIG. 7d ) and at projection 796 a(shown in FIG. 7f ) which may serve as a conduit for electrosurgicalenergy.

Grasping/control instrument 790 may comprise means for grasping and/orcontrolling lysing tip 710. “Controlling” herein may be described asincluding, but not limited to, the physical movement of lysing tip inany direction and/or orientation and the conduction of electrosurgicalenergy to lysing tip. Such grasping/control instrument 790 may comprisegrasping means fixed jaw 794, grasping means moveable upper jaw 793, andshaft 791 that may be comprised of additional means to grasp and/orpermit the flow of electrosurgical energy to the tip 710, such as wires,actuation rods, and the like. In some embodiments, grasping/controlinstrument 790 may further comprise a means for controlling lysing tip710 during a surgical procedure. Grasping/control instrument jaws793/794 may comprise, for example, closable jaws that may be configuredto grasp or otherwise engage linking member 715 via pad 718. An actuator(not shown) may be provided for controlling/actuating such jaws, oranother means for grasping lysing tip 710. Grasping/control instrument790 may be electroconductive in some embodiments such thatelectrosurgical energy may be delivered through jaws 793/794 to lysingtip 710. In some such embodiments, insulation, such as an insulatingcover, may be used to cover conductive areas of grasping/controlinstrument 790. In some embodiments, the insulation (if present) ongrasping/control instrument 790 may extend to at least partially ontojaws 793/794 to avoid delivering electrosurgical energy to undesiredtissues. In other embodiments, electrosurgical energy may be deliveredthrough another element of the system and, thus, grasping/controlinstrument jaws 793/794 may only be used to physically control tip 710and need not be formed from a conductive material (although still may beif desired).

In some embodiments and implementations, grasping/control instrument 790may be replaced with a device such as second transfer/grasping tip, suchas transfer grasping instrument 1796 as depicted in FIGS. 17f and 17g ,that may be used to facilitate coupling of lysing tip 710. In some suchembodiments and/or implementations, the lysing tip 710 may be deliveredthrough a separate cannula, which may comprise various elementspreviously mentioned for delivery of the lysing tip 710. Alternatively,the lysing tip 710 may be delivered through the same cannula that isultimately used to grasp and/or control the lysing tip 710 duringsurgery. In other words, the lysing tip 710 may be pushed out of thedistal end of cannula 732, after which grasping/control instrument 790may be used to grasp or otherwise couple to lysing tip 710 and used toperform a surgical procedure.

The embodiment in FIG. 7 is similar to the embodiment in FIG. 17 inrespect that the lysing tip may be passed down the inner cannula andgrasped by a second grasping instrument entering the body from anothercannula whereupon the second grasping instrument such as a needle driverand/or hemostat and/or clamp and/or the like may grasp the front of aforward portion of the lysing tip and feed pad 718 back into receivingslot 797 defined by upper and lower jaws 793 and 794.

In FIGS. 8a-f , a system 800 is depicted which may allow for maintainingcontrol of a free-floating lysing tip and/or facilitating coupling ofthe free-floating lysing tip with a jaw of a grasping controlinstrument. In system 800, a tether 844 extends through an opening 893 hformed in a jaw 893 of the grasping/control instrument 891. Examples oftethers may be cords, bands, wires, sutures or the like. As used herein,“free-floating” lysing tips are lysing tips that are releasably coupledwith the instrument(s) that are used to energize and/or control thelysing tips during a surgical procedure. Tether 844 may further beconfigured to be coupled with free-floating, tabbed lysing tip 810. Inthe depicted embodiment, tether 844 couples with grasping tab 818. Moreparticularly, grasping tab 818 comprises an opening 818 h configured toreceive the tether 844 as shown in the cross-sectional view of FIG. 8d .In some embodiments, the opening 818 h may comprise a blind opening.Alternatively, opening 818 h may comprise a through-hole. In someembodiments, tether 844 may comprise a distal bulb 844 c and/or stopthat prevents tether 844 from pulling through the opening 818 h. In thedepicted embodiment, bulb 844 c is configured to be received in a recess818 h′ formed in grasping tab 818. Recess 818 h′ may be a portion ofopening 818 h having a larger dimension.

In the depicted embodiment, by pulling on tether 844 either manually orby way of a mechanism, tip 810 may be configured to be directed into thejaws 893/894 of grasping/control instrument 891. In still otherembodiments, tether 844 may be coupled with tip 810 without alsoextending through one or both of jaws 893/894. In this manner the tip810 may be retrieved simply by pulling on the tether 844. In otherembodiments, a tether 844 may extend through other portions of thegrasping instrument, such as the bottom jaw 894 and/or both jaws 893/894and/or through the center of the grasping/control instrument 891. Thetether may be packaged with a tether already attached or medicalpersonnel at the procedure may choose an appropriate tether to threadand catch in the lysing tip and thread through the jaw with thethrough-hole.

In some embodiments, one or more cannulas 832 may be used to deliverand/or retrieve lysing tip 810. For example, instrument 891 and lysingtip 810 may be delivered within cannula 832. Alternatively, instrument891 and lysing tip 810 may be delivered without using a cannula in someembodiments and implementations.

In some embodiments such as that depicted in FIG. 8f , one or moremagnets 892 g on/in one or more jaws 893/894 of grasping controlinstrument 891 may be used to guide lysing tip 810 towards a desiredlocation such as within jaws 893/894. In some embodiments, one or moremagnets 892 t may be positioned along grasping tab 818. In alternativeembodiments, one or more magnets may be positioned along grasping tab818 and/or along one or both of jaws 893/894 (892 t and 892 grespectively).

FIG. 9 depicts a lysing tip comprising non-axial and/or substantiallynon-axial protrusions and a proximal tab. In this embodiment, one ormore protrusions 901 a/901 b/901 c/901 d, recessions 902, and/or lysingmember(s) 903 a/903 b/903 c may not be in an axial configuration. In allother respects, the lysing tip of FIG. 9 may be similar to that tipdepicted in FIGS. 7a-7f . In alternative embodiments, the lysing tipsmay be configured to all point in the same non-axial direction. In stillother embodiments, each corresponding protrusion or pair of protrusionsmay be configured to point in the same direction. In still otherembodiments, lysing segments and/or protrusions may be configured topoint perpendicular or substantially perpendicular to the axis.

FIGS. 10a-10h depict an embodiment of a CDTD 1000 comprising a pluralityof protrusions 1001 comprising the distal tips of beads 1051, comprisingindividual beads 1051 a/1051 b/1051 c/1051 d, coupled with one anotherby way of a single lysing member 1060, in the depicted embodiment, alysing rod 1060, extending through tunnels 1054 extending through eachof the respective beads 1051 a/1051 b/1051 c/1051 d. In this embodiment,lysing rod 1060 comprises a lysing rod 1060 that defines three separatelysing segments 1060 a/1060 b/1060 c formed between each bead, and, asdescribed above, may be used to deliver electrosurgical energy during asurgical procedure. Also, like the previously-described embodiments, theareas between each of the adjacent beads 1051 may define recessions 1002positioned in between adjacent protrusions (defined by beads 1051). Inthe depicted embodiment, each of the lysing segments is collectivelydefined by a single lysing rod 1060. However, other embodiments arecontemplated in which separate lysing members may be used for each ofthe lysing segments positioned between adjacent protrusions.

Beads 1051, or any of the other beads described herein, are preferablymade from a suitable inert, biocompatible, and non-conductive material,for example, such as a suitable plastic, alumina, zirconia, siliconnitride, silicon carbide, glass, graphite, silicate, diamond,carbon-containing compounds, cermet, or ceramic material or the like, ora combination of one or more of the foregoing.

In the depicted embodiment, lysing rod 1060 is positioned through beads1051 at a location such that beads 1051 may be non-symmetrical and/oreccentric relative to tunnels 1054. In other words, as best shown inFIG. 10c , tunnels 1054 more be positioned to extend through anon-central location within beads 1051. Moreover, in the depictedembodiment, beads 1051 are non-symmetrical relative to an axis extendingthrough the side-to-side centers of beads 1051 (perpendicular to thelong axis of the beads). In addition, as shown in the figures, thedistal/forward tip of beads 1051 may have a more narrowed end to actmore as a wedge for purposes of acting as a blunt dissector betweentissues and tissue planes; the proximal/non-distal/back portions beingless narrowed and/or larger in volume may create a desirable drag effectthus orienting the bead in a desirable direction for dissection. Whereasthe rear/proximal end of beads 1051 may take many shapes that may belarger and/or more prominent than that of the front/distal end of thebeads. As in FIG. 10d , the forward tip may be narrowed by use of facets1052; three are visible and numbered and the fourth is on the oppositeside of the one facing the reader. As described later in FIGS. 12 aa-rr,a wide variety of alternative bead shapes are possible including, forexample, ovoid shapes, spherical shapes, wheel shapes, bullet shapes orother shapes having a flat terminal end (such as, for example,frusto-shaped), wing shapes, etc. As can be seen from some of theexamples shown in FIGS. 12 aa-rr, in some embodiments, beads may besymmetrical relative to the openings for receiving the rod. In someembodiments, beads 1051 may be faceted on the top, bottom, sides, frontand/or back such as illustrated in FIGS. 10c and 10d , at facet 1052.Facets are preferably formed on the distal/front/leading portions of thebead to facilitate tip movement through/between tissue layers.

In some embodiments, the tunnels 1054 may be positioned in a non-centrallocation within beads 1051. For example, in some preferred embodiments,the tunnels 1054 may be positioned in a forward or distal locationrelative to a central axis of beads 1051. This may be preferable toallow the lysing tip 1010 to be directed through tissue in a desiredmanner, such as without allowing the beads 1051 to rotate on theirrespective tunnels in an undue manner. However, some embodiments may beconfigured to allow a certain amount of such rotation so that the tipcan be maneuvered through patient tissue in a flexible manner.

In some alternative embodiments, the forward or distal portions 1001 ofbeads relative to tunnels 1054 may also, or alternatively, be wider thansuch that beads 1051 have a trailing end that may be longer and/or morenarrow, which may yield desired aerodynamics and/or maneuverability;this may be similar to a ‘kite-tail’ effect.

Preferably, the entire surface of the beads may be smooth, however, somefaceting features may provide for a surface that is less smooth. Forexample, providing a smooth front end and a smooth trailing end mayallow the lysing tip to be moved in a forward direction and then in arearward direction back and forth without catching an undesirable amountof tissue on beads to inhibit such movement. However, as mentionedelsewhere in this disclosure, in some embodiments, the trailing end maycomprise a flat surface such that the entire bead comprises afrusto-ellipsoidal shape or another similar shape. Preferably, at leastthe forward or distal surface of the beads is smooth and defines anellipsoidal shape or another shape having an at least substantiallysmooth forward surface. In alternative embodiments, various portions ofthe bead may be textured or given surface irregularities that may yielda desired dissection orientation such as for example having thenon-proximal/rear portion of the bead roughened on the surface to createdrag from the rear.

In some embodiments, it may be desirable to allow beads 1051 to rotateon lysing rod 1060. Thus, beads 1051 may not be fixedthree-dimensionally with respect to lysing rod 1060 and/or one or moreother elements of lysing tip 1010. In some such embodiments, beads 1051may be at least partially rotatable with respect to the entire lysingtip 1010. For example, the beads may rotate about the rod uponencountering tissue similar to that of a vegetable/fruit peeler. Inembodiments in which beads 1051 are rotatable in this manner, it may bedesirable to use a lysing rod having a circular cross section. Otherembodiments are contemplated in which, instead of being rotatable, thebeads may be otherwise movable with respect to one or more elements of alysing tip 1010. In any such embodiments, such beads may be considerednot three-dimensionally fixed with respect to the lysing rod and/orlysing tip.

In the depicted in FIG. 10c , protuberances 1065 a/1065 b/1065 c/1065d/1065 e/1065 f formed on the lysing rod 1060 may be created to restrictlateral movement of the beads, and depending upon the distance from abead, may restrict or partially restrict rotational movement of thebeads around the axis of lysing rod 1060. In the preferredimplementation, a LASER or arc welder may be used to heat the conductivematerial comprising lysing rod 1060 causing liquefaction that cools intoa non-uniform structure that increases an outer diameter measurement oflysing rod 1060. Thus, in such embodiments and implementations,protuberances 1065 a/b/c/d may comprise “welds” that deform lysing rod1060. In alternative embodiments, “welds” may comprise added material tolysing rod 1060 through welding techniques in said locations and may belocated at any cross-sectional orientation including facing proximallyor distally. In alternative embodiments, crimps that mechanically deformthe metal at or substantially adjacent to beads may be utilized to holdbeads at particular locations on lysing rod 1060. In additionalembodiments, lysing rod 1060 may be deformed at locations where beads1051 are desired and couple at those locations via a friction fitbetween the bead tunnel and the lysing rod 1060.

Although allowing rotation of beads on a lysing rod may be desired forcertain surgical procedures, it may be desirable to prevent or at leastinhibit such rotation in other embodiments. Thus, in some suchembodiments, tunnels 1054 and/or the lysing rod 1060 may comprise anon-circular shape in cross-section to prevent or at least inhibit suchrotation. In alternative embodiments, beads 1051 may effectively bewelded to the lysing rod 1060 as an alternative method to inhibitrotation. Each bead may comprise hole 1055 that may be positionedperpendicular to lysing rod hole 1054; holes 1055 may be available as aplatform/location to add other features/components such as providing alocation for coupling of a cord as described below in connection withother embodiments and/or locating a sensor and/or RFID locationcomponent and/or being used for placement of luminescent and/or lightproduction element(s) for visualization, for example, tritium and thelike.

In alternative embodiments, hole 1055 d′ may be moved to fully orpartially intersect tunnel 1054 thus allowing communication with lysingrod 1060; thus a weld, plug (for example 1055 p), glue, insert or othermethod of fixation may be inserted via hole 1055 d′ to attach to lysingrod 1060 thus restricting lateral movement of a bead. To reduce escapeof electrosurgical energy through hole 1055 d′, an insulator comprisedof epoxy, plastic, ceramic or the like may be placed in part or all ofthe remaining hole 1055 d′. This alternative embodiment may be appliedto other embodiments herein.

In alternative embodiments, the lysing rod may lack coupling tips at itsoutermost portions. Instead any number of bead holes 1055 d′ may be madeat any number of angles to intersect the lysing rod 1060 and/or itstunnel 1054 to deposit a material that restrains the lysing rod withinthe bead 1051 (for example, materials may include welds, glues, epoxies,plugs, and the like). In such embodiments, tunnel 1054 may be a blindtunnel not requiring full passage through bead 1051 as bead 1051 may befixed/restrained internally (See for example FIGS. 20 j/k showing sideviews of beads 2051 a′ and 2051 a″. FIG. 20k shows full passage oftunnel 2054 which intersects with hole 2055′ (illustrated with dashedlines designating hole 2055′ being deeper in bead 2051′). FIG. 20jillustrates tunnel 2054′ which intersects with hole 2055′ (illustratedwith dashed lines designating hole 2055′ being deeper in bead 2051′) notextending to the outside of outer bead 2051″ (illustrated with dashedlines). This feature of this embodiment may be applied to otherembodiments herein. Beads may comprise facets 2052.

The shape of lysing member/lysing rod 1060 may also be important as tothe most efficient and safe means to transfer electrosurgical energyfrom the lysing rod to the tissue(s). Since electrosurgical energyon/under a surface tends to move toward edges of an object, a lysing rodwith a circular cross section may force current to the opposing lysingrod tips and/or protuberances creating hot spots at/near adjacent beadsand/or protuberances. Therefore, it may be beneficial for lysing rod1060 to comprise a non-circular cross section with substantially uniformedges along its length from which electrosurgical energy may uniformlybe transferred to tissues. In contemplated embodiments, a pentagonal orhexagonal cross-sectional shape may be preferable. In other embodiments,spacers with non-circular cross-sections may accumulate less debrisand/or eschar on lysing rod and/or spacer because debris may have a moredifficult time adhering to an angled edge when forces are applied to thedebris.

As shown in FIG. 10b , actuation rods 1021 and 1022 exit distally frominner/device cannula 1031. The distal terminations of actuation rods1021 and 1022 may contain holes in the distal area through which lysingrod 1060 may extend. Actuation rods 1021/1022 may terminate on theoutermost side of outer beads 1051 a and 1051 d. In alternativeembodiments, actuation rods 1021/1022 may be coupled to the lysing rod1060 between the two outer pairs of beads such as that shown in FIG. 17a.

Lysing rod 1060 may be held in position by features located on the endsof lysing rod 1060, namely coupling tips 1063 and 1064. Coupling tips1063/1064 may have diameters larger than the inner diameter of theircorresponding holes 1026 in actuation rods 1021/1022 respectively. Thecoupling tips may take various shapes. In FIG. 10c , coupling tip 1063comprises the shape of a mushroom cap and coupling tip 1064 comprisesthe shape of a ball. In alternative embodiments, other shapes may beused to couple the ends of lysing rod 1060 that effectively preventlysing rod 1060 from sliding through either hole 1026. Coupling tips1063/1064 may be made by for example by liquefying the ends by LASERand/or other heating and/or other metal modification methods; and inother embodiments, coupling tips may be separate structural elementssuch as screw-on nuts or the like. In some embodiments, it may bedesirable to provide features and/or elements that inhibit or limit theability of the electrosurgical energy to discharge from the opposingends of the lysing rod. Thus, in some such embodiments, coupling tips1063/1064 may be coated or covered with a suitable insulating materialsuch as an epoxy with non-conductive properties; this may apply to allembodiments herein.

FIGS. 10f and 10g demonstrate how the lysing tip 1010 transitionsbetween the delivery and treatment configurations. As shown in FIG. 10factuation rod 1022 comprises a first bend 1029 a which allows the rearportion of bead 1051 a to be received within a widened defined areadefined by bend 1029 a to allow lysing tip 1010 to pivot from atreatment configuration to a delivery configuration. As can be seen inthis figure, some embodiments may be configured such that lysing tip1010 is not aligned with the axis of cannulas 1031 or 1032 in thedelivery configuration. More particularly the axis of lysing tip 1010 ispositioned at an acute angle with respect to the axis of cannulas 1031or 1032. In some embodiments, a second bend 1029 b may be provided at ornear the distal end of actuation rod 1022 which second bend may be inthe opposite direction of first bend 1029 a, As shown in FIG. 10g , hole1026 is positioned in the middle of second bend 1029 b; second bend 1029b being part of hole 1026 may allow additional rotational movement oflysing rod 1060 as it pivots more toward the delivery configuration.

As shown in FIG. 10g , opening 1026 may be elongated in the direction ofor at least substantially in the direction of the axis of actuation rod1022 such that as lysing tip 1010 is repositioned between the treatmentand delivery configurations, the portion of lysing rod 1060 adjacent tocoupling tip 1064 can move/pivot within opening 1026 to allow lysing tip1010 to similarly pivot with respect to the axis of cannulas 1031 and/or1032. The shape of opening 1026 may be oval and/or rectangular or thelike. In other words, in the present embodiment, holes 1026 may beelongated shapes, for example, in the form of ovals or rectangles thatfacilitate the folding away of the lysing tip 1010 against the actuationrods 1021 and 1022. In some such embodiments or in alternativeembodiments internal beveling around the holes 1026 may facilitatemovement between treatment and delivery configurations. In someembodiments and implementations such as depicted in FIG. 10h , lysingtip 1010 may be configured such that its beads 1051 are too large to fitwithin the lumen of first/inner/device cannula 1031, even in thedelivery configuration. Thus, lysing tip 1010 in its deliveryconfiguration may be positioned just outside (immediately distal) offirst/inner/device cannula 1031 but within second/outer cannula 1032during delivery.

In the present embodiment, coupling tips 1063/1064 are not the sameshape and may be different as pre-formed lysing rods 1060 may bedelivered to the assembly line with mushroom-style coupling tips at oneend, and ball-style coupling tips may be the preferred method to createcoupling tips on a production line to fix the beads 1051 and lysing rod1060 into position relative to actuation rods 1021/1022.

In the present embodiment, actuation rods 1021 and 1022 are notcomprised of any pivotable hinges but are comprised of bends at variouslocations along actuating rods to facilitate deployment and control oflysing tip 1010. In alternative embodiments, hinges and/or control cordsmay be placed along the length of actuation rods to facilitate movementin other directions.

FIG. 10h depicts an alternative configuration similar to that of FIG.10f . However, in the configuration of FIG. 10h , the lysing tip 1010 isconfigured such that it cannot be fully received within cannula 1031. Insome embodiments and implementations, cannula 1031 may comprise an innercannula in which case an outer cannula (not shown in FIG. 10h ) may alsobe used. Preferably, in such configurations the lysing tip 1010 may befully received within the outer cannula in its delivery configuration.

FIG. 10e is a top view illustrating system 1000 that lysing rod 1060 maydeform when tip 1010 encounters resistance during a surgical procedure.In the figure, the center beads 1051 b/1051 c are pushed proximallydeforming lysing rod 1060.

System 1000 comprises means for fixing or guiding the ‘rotationalorientation’ of lysing tip 1010 with respect to first/inner/devicecannula 1031. In some embodiments the rotational fixing means may alsoprovide proximal support to lysing tip 1010 during a surgical procedure.Rotational fixing means 1033 is configured to engage actuation rods1021/1022. More particularly, in the depicted embodiment, rotationalfixing means 1033 comprises opposing slots 1033 a and 1033 b formed inthe distal end of first/inner/device cannula 1031, which slots aresized, shaped, and configured to receive at least a portion of actuationrods 1021/1022 when deployed distally. Other examples of rotationalfixing means 1033 include hooks, catches, etc. In addition, in anotherexample of a rotational fixing means, corresponding features on thedeployment side of lysing tip 1010 may engage the distal end or specialfeatures designed in the distal end of first/inner/device cannula 1031,in some embodiments 1033 a and/or 1033 b, and such seating may providedirect support restricting proximal movement and/or fixing the tipagainst rotation.

Each bead may have a height BH as illustrated in FIG. 10d and a lengthBL extending perpendicular to the axis of the lysing rod 1060. Each beadalso has a width BW as shown in FIG. 10e . Similarly, lysing tip 1010may have a length TL which preferably extends in the same direction asthe axis of lysing rod 1060 and a tip width TW extending perpendicularto the tip length TL as shown in FIG. 10e and a tip height TH as shownin FIG. 10d . In some embodiments, the tip height TH may be identical tothe bead height BH. However, in other embodiments, the tip height maydiffer from the bead height.

FIGS. 11a-11e depict various views similar to those depicted in FIGS.10a-10h for an alternative embodiment of a CDTD system 1100. System 1100differs from system 1000 in that spacers 1162 a/1162 b/1162 c may bepositioned between bead pairs 1151 a/1151 b, 1151 b/1151 c, and 1151c/1151 d. System 1100 is comprised of first/inner/device cannula 1131and second/outer cannula 1132 through which lysing tip 1110 may bedeployed or retrieved via actuation rods 1121 and 1122. In the depictedembodiment, each of the respective lysing segments between each beadpair comprises a spacer 1162 (1162 a/1162 b/1162 c) that may beconfigured to space the various beads 1151 apart, provide stability tothe lysing tip, and/or protect the respective lysing segments (which, inthe depicted embodiment, are collectively defined by a single lysingmember/lysing rod 1160). Preferably, spacers 1162 comprise a conductivematerial, such as a suitable biocompatible metal, that can receiveelectrosurgical energy from the lysing member 1160 and deliver it tovarious body tissues during a surgical procedure. Preferably, spacer(s)1162 are therefore in direct contact with lysing member 1160. In someembodiments, a single spacer 1162 may both extend between the variousbeads 1151 and extend through the tunnels 1154 through the beads 1151.Lysing rod 1160 terminates on its opposing ends at coupling tips 1163and 1164 that may hold the bead/lysing rod/spacer components in positionbetween actuation rods 1121 and 1122. Each bead may comprise hole 1155that may be positioned perpendicular to lysing rod hole 1154; holes 1155may be available as a platform/location to add otherfeatures/embodiments and/or to be used for cord/suture attachments forlysing tip manipulation and/or removal and/or be used for placement ofluminescent and/or light production for visualization, for example,tritium and the like. Each bead 1151 may comprise one or more facets1152.

Spacers 1162 a/1162 b/1162 c may be coupled with lysing rod 1160 by, forexample, sliding spacers 1162 comprising a lumen along the axis oflysing rod 1160. Alternatively, spacers 1162 may be coupled with lysingrod 1160 by placing spacers 1162 over lysing rod 1160 in a directionperpendicular to the axis of the lysing rod at a desired location usinga slot or other opening formed along a portion of a perimeter spacer1162. For example, spacers may be provided with a slit extending alongtheir respective axes. Such spacers may then be coupled with a lysingrod by aligning the slit with the lysing rod and pressing the spacertowards the lysing rod to snap it in place. In some embodiments andimplementations, spacers 1162 may be crimped or otherwise fixedlycoupled with lysing rod 1160 at a desired location. In some embodiments,this fixed coupling may be configured to prevent the relative movementbetween lysing rod 1160 and spacer 1162 possibly reducing hot spotscaused from high current density flow in certain areas between lysingrod 1160 and spacer 1162. These exemplary methods for applying spacersto a lysing rod and/or another lysing member may be apply to any of theother embodiments utilizing spacers.

In some contemplated embodiments spacers may be comprised of insulatingmaterials (such as ceramic, glass, plastic and the like) that may haveholes (illustrated in FIG. 12j ) and/or be porous and/or have breaksand/or have separations such that energy from lysing member(s) withinmay be released into target tissues.

In some such embodiments, beads 1151 may be at least partially rotatablewith respect to the entire lysing tip 1110. In embodiments in whichbeads 1151 are rotatable in this manner, it may be desirable to use alysing rod having a circular cross section. It may also be desirable toeither omit spacers 1162 or form them without the beveled edges as shownin 12 i and 12 j.

Spacers 1162 may be used to prevent rotation of beads 1151 or toselectively limit the amount of rotation of beads 1151 on a lysingmember 1160. For example, if spacers 1162 extend the entire distance orat least substantially the entire distance between each adjacent bead,spacers may prevent rotation or, depending upon the distance betweenspacers and adjacent beads, may be used to allow for a predeterminedamount of such rotation. Similarly, the opposing ends of spacers 1162may be shaped to match or at least substantially match the shape of theadjacent bead(s) again to either prevent or control rotation.

The shape of lysing member/lysing rod 1160 and/or spacers 1162 may alsobe important so as to provide selective energy-to-tissue delivery.Electrosurgical energy on/under a surface may tend to move toward edgesof an object. In some embodiments, therefore, it may be beneficial forlysing rod 1160 and/or spacer 1162 to comprise a non-circular crosssection with acute or substantially acute cross-sectional angles alongits perimeter thus creating a lysing rod with edges that may increaseelectrosurgical energy discharge in those areas. In contemplatedembodiments, a pentagonal or hexagonal cross-sectional shape may bepreferable. Additionally, spacers with non-circular cross-sections mayaccumulate less debris and/or eschar on lysing rod and/or spacer becausedebris may have a more difficult time adhering to an angled edge.

System 1100 is otherwise similar to system 1000. For example, system1100 comprises areas between each of the adjacent beads 1151 that definerecessions 1102 positioned in between adjacent protrusions 1101 (definedby distal/leading portions of beads 1151). In addition, lysing rod 1160defines lysing segments that are positioned between each of the adjacentbeads 1151.

In some embodiments, the tunnels 1154 may be shaped and/or sized suchthat the lysing rod 1160 alone can provide the needed rigidity andstructure to separate beads 1151 without providing spacers.

In some embodiments and implementations such as depicted in FIG. 11f ,lysing tip 1110 may be configured such that its beads 1151 are too largeto fit within the lumen of first/inner/device cannula 1131, even in thedelivery configuration. Thus, lysing tip 1110 in its deliveryconfiguration may be positioned just outside (immediately distal) offirst/inner/device cannula 1131 but within second/outer cannula 1132during delivery.

FIGS. 12a -12 rr depict 3 general components of the lysing tip andvarious potential shapes: Lysing rod (FIGS. 12a-12g ), spacers (FIGS.12h-12t ), and beads (FIGS. 12 aa-12 rr).

FIGS. 12a-12g depict various examples of cross-sectional shapes of wiresor other lysing members. In some embodiments, these shapes may be formedby crimping a wire or other suitable lysing member into the desiredshape. Crimping the lysing member may be particularly useful inconnection with certain embodiments and/or implementations of theinvention, as it may facilitate a preferred coupling between variousother elements of the CDTD system, such as the beads and/or spacers.Crimping may also, or alternatively, be useful in providing for apreferred delivery of electrosurgical energy through the wire/lysingmember. Other methods of shaping the lysing member may include but notbe limited to cutting, polishing, forging or forming by extrusion. Inadditional embodiments, various coatings may be applied to lysing rodsthat may reduce adhesion of heated biological material to the lysing rodor spacers.

FIG. 12a comprises a lysing rod having a circular cross-section. Theshape of lysing member/lysing rods may also be important as to the mostefficient and safe means to transfer electrosurgical energy from thelysing members to the tissue(s). Electrosurgical energy on/under asurface may tend to move toward edges of an object. This shape may beuseful for allowing a useful distribution of a coating to the surface ofthe lysing rod that may be used to reduce char buildup and/or modifyease of movement of a lysing tip through tissue. FIG. 12b comprises alysing rod having a triangular cross-section; this may be useful formaximizing electrosurgical energy discharge and minimizing char build-upabout the lysing rod. FIG. 12c comprises a lysing rod having a squarecross-section. FIG. 12d comprises a lysing rod having a pentagonalcross-section along its length while FIG. 12 dx comprises a lysing rodhaving a pentagonal cross-section that is twisted along its length. FIG.12e comprises a lysing rod having a hexagonal cross-section. FIG. 12fcomprises a lysing rod having a wedge-shaped cross-section. FIG. 12gcomprises a lysing rod having a semi-circular or frusto-circularcross-section.

FIGS. 12h-12t depict various shapes for spacers that may be used inconnection with one or more of the embodiments disclosed herein. Eachmay have a hole through which lysing members may extend. As illustratedin these figures, FIG. 12h illustrates a spacer having flat ends and acylindrical shape. FIG. 12i illustrates a spacer having a circularcross-section and tapered ends which may be useful for allowing adesired distribution of a coating to the surface of the spacer to reducechar buildup and/or modify ease of movement of a lysing tip throughtissue. FIG. 12j comprises various openings, such as holes, for deliveryof electrosurgical energy therethrough; this may allow for makingspacers of a non-conductive material and still deliver such energytherethrough. FIG. 12k illustrates an alternative spacer that is arced.FIGS. 12L (resting) and 12 m (stressed) illustrate an alternative spacerhaving opposing loops with central openings configured to allow forreceipt of a wire or other lysing rod therethrough and a flexibleconnector extending between the two loops. As shown in FIG. 12m , oncecoupled with adjacent beads (not shown), the flexible connector may bendto serve as a brace and space apart the adjacent beads. This spacer mayalso be configured such that the opposing loops may be flexed to theside to allow for coupling of adjacent beads and receipt of a lysing rodtherethrough (not shown). FIG. 12n illustrates a cross-sectional view ofanother spacer having a triangular cross-sectional shape and an openingfor receipt of a lysing rod therethrough. FIG. 12o illustrates across-sectional view of another spacer having a rectangularcross-sectional shape and an opening for receipt of a lysing rodtherethrough. FIG. 12p illustrates a cross-sectional view of anotherspacer having a pentagonal cross-sectional shape along its length and anopening for receipt of a lysing rod therethrough while FIG. 12 pxcomprises a spacer having a pentagonal cross-section that is twistedalong its length and an opening for receipt of a lysing rodtherethrough. Spacers with twisted features may acquire less debrisalong its surface and may tend to rotate thus multiple sides of a spacerare exposed to charred tissue. FIG. 12q illustrates a cross-sectionalview of another spacer having a hexagonal cross-sectional shape and anopening for receipt of a lysing rod therethrough. FIG. 12r illustrates ablade-style cross-sectional shape with smooth, rounded outer surfacesthat meet at the distal edge and an opening for receipt of a lysing wireor other lysing rod therethrough. FIG. 12s illustrates a cross-sectionalview of another spacer having a blade cross-sectional shape (differingfrom FIG. 12r in that outer surfaces are formed by intersectingplanar/flat surfaces) and an opening for receipt of a lysing wire orother lysing rod therethrough. FIG. 12t illustrates a cross-sectionalview of another spacer having a spindle cross-sectional shape and anopening for receipt of a lysing wire or other lysing rod therethrough.

The cross-sectional shape of the exterior surface of spacers 12-4 mayalso be important as to the most efficient and safe means to transferelectrosurgical energy from spacers to the tissue(s). Electrosurgicalenergy on/under a surface may tend to move toward edges of an object, soa spacer with an exterior surface having a circular cross section mayforce current to the opposing spacer ends creating hot spots at/nearadjacent beads. Therefore, it may be beneficial for spacers to comprisean exterior surface having a non-circular cross section with one or moresubstantially uniform edges along its length from which electrosurgicalenergy may uniformly be transferred to tissues. In contemplatedembodiments, a pentagonal or hexagonal cross-sectional shape may bepreferable. Additionally, spacers with non-circular cross-sections mayaccumulate less debris and/or eschar on lysing rod and/or spacer becausedebris may have a more difficult time adhering to an angled edge. Insome embodiments, one or more (in some embodiments, all) of the spacersmay comprise a leading edge for delivery of electrosurgical energy fromthe lysing member(s). In some such embodiments, one or more of thespacers may comprise only a single such leading edge. In some suchembodiments, the spacer(s) may comprise a smooth, or at leastsubstantially smooth, exterior surface, other than the single leadingedge. For example, the spacer(s) (or, in some embodiments, the lysingmember/rod itself) may comprise a circular or oval shape in crosssection with a flattened leading end terminating in a leading edge. Thismay be useful for controlling the delivery of electrosurgical energy.

Because the spacers may be configured to receive the lysing member/rodtherethrough, the spacers may also comprise an opening extendingtherethrough for receiving the lysing member/rod. Thus, the spacers mayalso have an interior cross-sectional shape, which may differ from theshape of the exterior surface. For example, it may be useful to form thespacers with an opening having a cross-sectional shape that matches thecross-sectional shape of the lysing member/rod. Thus, if the lysingmember/rod comprises a circular or polygonal shape in cross-section, thespacer(s) may comprise an opening having a similar cross-sectionalshape. In some embodiments, the shape of the exterior surface of thespacers may therefore be used to primarily dictate preferred deliverylocations for the electrosurgical energy.

FIGS. 12 aa-12 rr show 12-5 alternative shapes for beads positionedalong a lysing tip. As illustrated in these figures, bead shapes thatmay be useful may include spheres (FIG. 12 aa), wheel shapes (FIG. 12bb), dodecahedron shapes (FIG. 12 cc). In other embodiments, bead shapesmay be bullet-shaped or partially or substantially ellipsoidal (FIGS. 12dd-12 ff) and may have facets (FIGS. 12 ee and 12 ff). In othercontemplated embodiments, beads of various geometries may be cut offhaving flat or slightly curved proximal surfaces or further shaped bygeometric cuts (FIGS. 12 gg-12LL) (herein, this may be referred to as“frusto-shaped”). In other contemplated embodiments, bead shapes and/ortunnels through them may be uniform spherical and/or centered. In othercontemplated embodiments, beads may have skeleton features supported bya hub that may be adjacent to the lysing rod or adjacent to or formedaround a ceramic sleeve through which a lysing rod is extended (FIGS. 12mm-12 rr). 12-6 In some contemplated embodiments, providing a roughtrailing end may create frictional drag on that portion of the bead thushelping reorient the front end of the bead for further tissue passage.Thus, in some embodiments, the trailing end may have a rougher surfacethan the front end. For example, in some embodiments, the trailing end,or at least a portion of the trailing end, of one or more beads may besanded with a rougher sanding material than the leading end, may beformed with ridges, grooves, or other roughening elements, or mayotherwise be made with a less smooth surface for this purpose. In somecontemplated embodiments such as that depicted in FIG. 12 rr, a bead maycomprise a slot beginning at its trailing end and terminating within thebead 12 rr so as to allow for receipt of a lysing rod therein. In somesuch embodiments, a hole 1255 may be positioned to extend through thebead and may at least partially intersect with slot 1253. Thus a weld,plug, glue, insert or other method of fixation may be inserted via hole1255 to attach to a lysing rod thus restricting movement of a beadand/or rotation of the bead with respect to its lysing rod.

In alternative embodiments, beads may comprise a conductive materialsuch as metal and coated with an insulator; for example, a bead shapedsuch as FIG. 12 rr but made of metal (internally) may be pressed over alysing rod with increased pressure closing the slot behind the lysingrod causing the bead to remain in place along a lysing rod.

FIGS. 13a-13i depict another embodiment of a CDTD system 1300 comprisinga plurality of beads 1351 positioned on lysing member 1360 whichcomprises lysing plate 1360. It should be noted that in the embodimentsof 13 a-13 i, beads 1351 are supported laterally by lysing plate 1360.It should also be noted that beads 1351 lack a base, such as base 105for system 100, and instead define a lysing tip that lacks structureimmediately behind the beads for support. It should also be noted thatlysing tip 1310 comprises beads 1351 (1351 a/1351 b/1351 c/1351 d) thatproject both distally and proximally relative to lysing plate 1360.

System 1300 may be configured to allow for repositioning of lysing tip1310 between a delivery configuration and a treatment configuration. Inthe delivery configuration, the axis of each of the elongated beads 1351towards the treatment side may be configured to extend in a directionthat is at least substantially perpendicular to the cannula axis andlysing tip 1310 (the axis between the two outer beads 1351 a/1351 d) maybe configured to extend in a direction that is at least substantiallyparallel to the cannula axis. In addition, in the depicted embodiment,lysing tip 1310 may be configured such that an energy delivery side oflysing tip 1310 in front of protrusions 1301 defined by theleading/proximal tips of beads 1351 and the relative recessions 1302,which energy delivery side will ultimately deliver electrosurgicalenergy for dissecting tissue, faces an interior surface of a lumen ofcannula 1331 through which lysing tip 1310 is delivered. Followingdelivery of lysing tip 1310 through a distal end of cannula 1331, system1300 may be configured to reposition lysing tip 1310 to the treatmentconfiguration in which the energy delivery side extends at leastsubstantially perpendicular to the cannula axis.

As shown in FIG. 13d , system 1300 comprises two separate cannulas,namely, a first or first/inner/device cannula 1331 which preferablycomprises a lumen of sufficient diameter to allow folded lysing tip 1310(in a delivery configuration) to be positioned within the lumen offirst/inner/device cannula 1331, and a second cannula 1332, which mayhave a larger cross-sectional diameter. In some embodiments andimplementations, lysing tip 1310 may be configured such that its beads1351 are too large to fit within the lumen of first/inner/device cannula1331, even in the delivery configuration. Thus, lysing tip 1310 in itsdelivery configuration may be positioned just outside (immediatelydistal) of first/inner/device cannula 1331 but within second/outercannula 1332 during delivery. By providing two co-axial cannulas,actuation rods 1321 and 1322 and/or actuation rod pairs 1321/1323 and1322/1324 may be prevented, or at least substantially prevented, frombeing separated from one another or otherwise system 1300 may beconfigured to maintain better control over lysing tip 1310 duringdeployment. Thus, preferably, actuation rods 1321/1322 and/or actuationrod pairs 1321/1323 and 1322/1324 are also delivered throughfirst/inner/device cannula 1331. Retraction 1325 is preferably near tip1310 at or near the distal end of one of actuation rods 1321/1322.

In this embodiment, distal actuation rods 1321 and 1322 are formed withtwo bends that bring the distal end of the actuation rods perpendicularwith the main axis of the actuation rods but parallel to the elongatedaxis of the lysing plate 1360 in the treatment configuration. Thisconfiguration may be advantageous during the delivery configuration tooptimize the volume needs within cannulas. In the present embodiment,actuation rods 1321 and 1322 may have cutouts in the distal tipsallowing for lysing plate 1360 to be received in the distal tips ofactuation rods 1321/1322. Alternatively, the lysing plate 1360 maycomprise recesses that permit the actuation rods 1321/1322 to seatwithin the lysing plate 1360.

Lysing tip 1310 may comprise an orientational-deployment side oppositefrom the energy delivery side. The orientational-deployment side oflysing tip 1310 may be configured to allow lysing tip 1310 to berepositioned between the delivery configuration and the treatmentconfiguration described above. A deployment assembly may be coupled withthe orientational-deployment side of lysing tip 1310. This deploymentassembly may be configured to allow for selective repositioning betweenthe delivery and treatment configurations. In the depicted embodiment,the deployment assembly may comprise one or more pivot members, such aspivot members 1316 and 1317. Pivot members 1316 and/or 1317 may comprisevarious elements configured to allow for selective pivoting, rotation,and/or angulation of lysing tip 1310, such as joints, ball pivots,hinges, pins, groove/slot pairs, etc., such that lysing tip 1310 can bepivoted, rotated, or “folded” between its deployment and treatmentconfigurations.

Pivot members 1316 and 1317, such as pins or the like, may be coupled atone end to the lysing plate 1360 at holes 1368 a and 1368 b and may befurther coupled with actuation rods 1322 and 1321, respectively. In someembodiments, pivot members 1316/1317 may therefore be configured to bereceived in holes formed in both lysing plate 1360 and correspondingaligned holes formed within actuations rods 1321/1322. Thus, uponadvancing one or both of actuation rods 1322 and 1323, lysing tip 1310may be advanced in its delivery configuration down first/inner/devicecannula 1331. In some embodiments, appropriate wires or othertransmission lines for delivery of electrosurgical energy may bepositioned to extend through one or more of the various actuation rods.Alternatively, in some embodiments, electrosurgical energy may bedelivered directly through one or more actuation rods. In someembodiments, wires or other transmission lines for delivery ofelectrosurgical energy may instead, or additionally, extend though otherregions of lumen, as previously described. Actuation rods 1321 and/or1322 and/or actuation rod pairs 1321/1323 or 1322/1324 may comprise anysuitable material depending on whether electrosurgical energy is beingdelivered through them. For example, a metal or other conductivematerial may be used if electrosurgical energy is to be deliveredthrough the actuation rods, or a plastic or other insulating materialmay be used if electrosurgical energy is to be delivered throughseparate wiring or other suitable transmission lines.

Some embodiments may further comprise one or more additional jointsand/or pivot members positioned proximally relative to pivot members1316 and 1317. For example, some such embodiments may comprise hingesand/or pivot members 1327/1328 that are positioned within one or both ofactuation rod pairs 1321/1323 or 1322/1324, as previously described inFIGS. 1a-j . Such hinges may allow for one or both of distal actuationrods 1321/1322 to be pivoted/rotated in a desired direction once lysingtip 1310 has exited the terminal end of cannula 1331 and/or 1332.

System 1300 differs from Systems 800 and 900 in that lysing member 1360comprises a plate 1360. Plate 1360 may extend through horizontal tunnels1352 within the various beads 1351. Beads 1351 may also have verticaltunnels 1355. Thus, beads 1351 may be more permanently coupled withplate 1360 by way of holes within plate 1360, such as 1369 a/1369 b/1369c/1369 d formed within plate 1360 configured to correspond to holes 1355located in beads 1351. In some embodiments, pins, screws, rivets or thelike or epoxy, or metallic welds may extend through vertical tunnels1355 and holes 1369 a/1369 b/1369 c/1369 d to affix the two elementstogether. In alternative embodiments, holes 1369 a/1369 b/1369 c/1369 dmay be replaced by bevels. Thus, in some embodiments, horizontal and/orvertical tunnels may not be needed. However, in other embodiments, plate1360 may comprise beveled or narrowed regions configured to fit withinsuch tunnels formed within beads 1351. Because use of a plate 1360 mayprovide more rigidity than certain other embodiments, use of spacers maynot be needed for lysing tip 1300.

System 1300 comprises areas between each of the adjacent protrusions1301 (defined by the distal/front ends of adjacent beads 1351 a-d) thatdefine recessions 1302.

Plate 1360 may define lysing segments 1360 a/1360 b/1360 c that arepositioned between each of the adjacent beads 1351 a-d. Each of theselysing segments may be collectively defined by a single lysingmember/plate 1360 or, in other embodiments, separate lysingmembers/plates may be used for each of the lysing segments positionedbetween adjacent protrusions/beads.

As shown in FIG. 13d , the hinge structure may allow for rotation oflysing tip 1310 above and/or below the cross-sectional profile ofcannula 1331 and/or 1332 and may allow lysing tip 1310 to extend beyondthe cross-sectional profile of cannula 1331 and/or 1332 along one orboth of the opposing ends of the lysing tip 1310.

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 1331 may vary as forexample, as shown in FIGS. 16k and 16L. In other words, the lysing tip1310 in the axial deployment configuration may be unable to be receivedwithin cannula 1331 such as shown in FIG. 16L or may be unable to bereceived within an inner cannula of two delivery cannulas as shown inFIG. 16k . In embodiments comprising two cannulas, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only need to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Such embodiments may be useful for cosmeticprocedures within the skin, for example, but not limited to, for facelifting and/or cellulite treatment.

Another embodiment is depicted in FIGS. 14a-14n . System 1400 compriseslysing tip 1410 comprising recessions 1402 created by adjacentprotrusions 1401. Lysing tip 1410 further comprises a support member1470 defining a bow shape through which holes 1472 and 1473 extendvertically. In the depicted embodiment, hole 1472 is offset from hole1473 on support member 1470, such as with respect to the lysing rod1460, for example. This may facilitate a preferred pivoting of lysingtip 1410 between treatment and delivery configurations. Holes 1472/1473may configured to receive pins for coupling lysing tip 1410 to actuationrods 1422 and 1421 respectively. Support member 1470 and/or holes1472/1473, in some embodiments, may not be symmetrical with respect toone or more points and/or axes, such as one or more central axes oflysing tip 1410, such as the axis defined by lysing rod 1460 and/or thecenter axis of the lysing tip 1410 from a plan view extending betweenthe treatment and deployment/orientation sides of the lysing tip 1410,in order to facilitate movement between the treatment and deliveryconfigurations. For example, in the depicted embodiment, if an XY gridis imposed over FIG. 14g with the Y-axis bifurcating lysing rod 1460 andthe X-axis touches the lower most feature of support member 1470, thenholes 1472 and 1473 may not have the same y-coordinate. In other words,holes 1472 and 1473 may be positioned at different distances from lysingrod 1460 or are non-symmetrical with respect to lysing rod 1460.Furthermore, in some embodiments, holes 1472/1473 may be positioned atdifferent distances from the center of support member 1470.

Support member 1470 may be preferably insulated, except within one orboth sets of its two sets of holes, to prevent unwanted delivery ofelectrosurgical energy to tissues; thus, electrosurgical energy isdirected to support member holes at which lysing rod 1460 becomesenergized for energy delivery.

In the depicted embodiment, knobs 1475 a and 1475 b are provided onsupport member 1470 in order to provide additional material support suchthat holes 1472 and 1473 can be formed in a desired location. In thisembodiment, holes 1472 and 1473 may be positioned within and/or adjacentto knobs 1475 a and 1475 b respectively.

Lysing tip receptacle 1421 a on distal actuation rod 1421 comprises acutout formed in the distal control arm into which the bottom of supportmember 1470 recesses. In other embodiments, the lysing tip receptaclemay instead comprise a recess that is not fully cut out.

Actuation rod 1422 further comprises opening 1422 a such that whenlysing tip 1410 is in the delivery configuration, fastening member ofhinge 1427 enters opening 1422 a to facilitate maximum proximal movementof the actuation rods relative to each other.

As shown in FIG. 14c , system 1400 comprises two separate cannulas,namely, an outer cannula 1432 which preferably comprises a lumen ofsufficient diameter to allow folded lysing tip 1410 (in a deliveryconfiguration) to be positioned within the lumen of cannula 1432, and asecond inner/device cannula 1431 which comprises a lumen of sufficientdiameter to allow folded lysing tip 1410 (in a delivery configuration)to be positioned within the lumen of cannula 1431. In certainembodiments, such as in FIGS. 14i and 14j , lysing tip 1410 in thedelivery configuration may have one or more cross-sectional dimensionsthat may exceed the inner diameter of inner/device cannula 1431 and thusmay not retract partially or fully into inner/device cannula 1431.However, in some such embodiments, lysing tip 1410 may still retractfully into outer cannula 1432 during deployment or retraction. Moreparticularly, lysing tip 1410 may be configured such that its beads 1451a/b/c/d are too large to fit within the lumen of inner/device cannula1431, even in the delivery configuration. Thus, lysing tip 1410 in itsdelivery configuration may be positioned just outside (immediatelydistal) of inner/device cannula 1431 but within outer cannula 1432during delivery.

Any of the embodiments described herein may be configured such that thetip 1410 cannot be fully received within second cannula 1432 as shown inFIG. 14c . Or alternatively, any of the embodiments disclosed hereinsuch that the entire tip may be fully received within first/inner/devicecannula 1431. This embodiment may be useful because it permits the tipto be as large as possible given the dimension constraints of the outercannula and not the inner cannula thus reducing the expense of furtherminiaturizing.

Some embodiments may be configured such that lysing tip 1410 is notaligned with the axis of cannulas 1431 or 1432 in the deliveryconfiguration. More particularly the axis of lysing tip 110 may bepositioned at an acute angle with respect to the axis of cannulas 1431or 1432. In other embodiments, lysing tip 1410 may be configured toextend at an acute angle relative to the cannula axis so long as theaxis of lysing tip 1410 fits within the lumen and/or lumens of oneand/or both cannulas such as illustrated in FIG. 10f or 11 f

By providing two co-axial cannulas, actuation rods 1421 and 1422 may beprevented, or at least substantially prevented, from being separatedfrom one another or otherwise system 1400 may be configured to maintainbetter control over lysing tip 1410 during deployment. Thus, preferably,actuation rods 1421 and 1422 are delivered through both cannulas 1431and 1432.

Lysing rod 1460 extends through all beads and terminates in outer beads1451 a/1451 d coupling all beads with lysing rod 1460 and structuralmember 1470 via coupling tips 1463 terminating within outer beads 1451a/1451 d. In this embodiment, the configuration of the tunnels in themiddle and end beads may capture corresponding elements as described inprevious embodiments. In some embodiments, it may be desirable toprovide features and/or elements that inhibit or limit the ability ofthe electrosurgical energy to discharge from the opposing ends of thelysing rod 1460 at coupling tips 1463/1464. Thus, in some suchembodiments, coupling tips 1463/1464 may be coated or covered with asuitable insulating material such as an epoxy with non-conductiveproperties. Alternatively, outer bead hole 1454 at the end with thelarger-opening may be capped or plugged with an element configured to bereceived or otherwise engage the larger opening of the bead. Preferably,this element will have non-conductive properties similar to theinsulating material previously referenced.

In this embodiment, spacers 1462 a/1462 b/1462 c may be positionedbetween bead pairs 1451 a/1451 b, 1451 b/1451 c, and 1451 c/1451 d. Inthe depicted embodiment, each of the respective lysing segments betweeneach bead pair comprises a spacer 1462 (1462 a/1462 b/1462 c) that maybe configured to space the various beads 1451 a/b/c/d apart, providestability to the lysing tip, and/or protect the respective lysingsegments (which, in the depicted embodiment, are collectively defined bya single lysing member/lysing rod 1460). Preferably, spacers 1462comprise a conductive material, such as a suitable biocompatible metal,that can receive electrosurgical energy from the lysing member 1460 anddeliver it to various internal body tissues during a surgical procedure.Preferably, spacer(s) 1462 are therefore in direct contact with lysingmember 1460. In some embodiments, a single spacer 1462 may both extendbetween the various beads 1451 a/b/c/d and extend through the tunnels1454 through the beads 1451 a/b/c/d. In some contemplated embodiments,spacers may be comprised of insulating materials (such as ceramic,glass, plastic and the like) that may have holes and/or be porous and/orhave breaks and/or have separations such that energy from lysingmember(s) within may be released into target tissues to have effect suchas that illustrated in FIG. 12j . As discussed earlier, in someembodiments, spacers may have a circular cross-sectional profile whichmay facilitate adhesion of surface coatings which may have functions,including but not limited to, such as reduction in char buildup and/orease of movement of lysing tip through tissue. However, in someembodiments electrical discharge may be enhanced across the length ofthe lysing member 1460 via a cross sectional profile with acute orsubstantially acute angles, for example, pentagonal or hexagonal shapes.Additionally, spacers with non-circular cross-sections may accumulateless debris and/or eschar on lysing rod and/or spacer because debris mayhave a more difficult time adhering to an angled edge.

Beads 1451 a-d may be positioned along lysing rod 1460 differently inalternative embodiments. For example, in FIG. 14h , in some embodiments,spacers 1462 a-c may be removed and protuberances 1465 c/1465 d such aswelds may be placed on each side of the middle beads 1451 b/c and mayface proximally, distally or therebetween. In alternative embodiments,spacers 1462 a-c may be removed and lysing rod 1460 may be deformed oneach side of the middle beads 1451 b/c such that the beads may not slidepast the deformation. With respect to such embodiments, thesedeformations may also be considered protuberances as this term is usedherein. In alternative embodiments, spacers 1462 a-c may be removed andlysing rod 1460 may be deformed, such as flattening, making ellipsoidalin cross section, or otherwise modified, prior to coupling with themiddle bead(s) such that the outer diameter of lysing rod 1460 maycouple via friction fit with the inner tunnel surface of middle beads1451 b/c. In alternative embodiments, spacers 1462 a-c may be deformedon lysing rod 1460 to a degree that spacers may no longer rotate aroundlysing rod 1460 and the new cross-sectional shape of spacers 1462 a-cmay have a beneficial effect.

In the current embodiment, outer beads 1451 a and 1451 d are theapproximate same length as middle beads 1451 b and 1451 c; this shorterouter bead configuration may allow for more complete folding of thelysing tip during the delivery configuration.

Retraction guide 1425 is preferably near tip 1410 at or near the distalend of one of actuation rods 1421/1422. In the depicted embodiment,retraction guide 1425 is positioned near the distal end of actuation rod1422 adjacent to (immediately proximal of) tip 1410. In someembodiments, retraction guide 1425 may comprise a resilient material,such as a spring, so that it provides a restorative force duringretraction of tip 1410 into cannula 1431. Preferably, retraction guide1425 is positioned and configured so as to extend from actuation rod1422 laterally by a distance at least approximately equal to, in someembodiments slightly greater than, the distance one or more of theprotrusions 1401 that extend laterally relative to actuation rod 1422 inthe retracted/folded configuration. In some embodiments, retractionguide 1425 may extend in this direction a distance equal to, or slightlygreater than, the largest protrusion 1401 (in embodiments in which eachof the protrusions are not identical and/or do not project an equaldistance).

It should be understood that embodiments are contemplated wherein thedimensions of the tip relative to a cannula 1431 may vary as forexample, as shown in FIGS. 14k and 14L. In other words, the lysing tip1410 in the axial deployment configuration may be unable to be receivedwithin cannula 1431 such as shown in FIG. 14L or may be unable to bereceived within an inner cannula of two delivery cannulas as shown inFIG. 14k . In embodiments comprising two cannulas, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only need to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Such embodiments may be useful for cosmeticprocedures within the skin, for example, but not limited to, for facelifting and/or cellulite treatment.

Some embodiments could be configured to allow for treatment to takeplace from the tip at a non-perpendicular angle relative to the axis ofthe cannula. In some such embodiments, this non-perpendicular angle mayeven allow the tip to be withdrawn in this treatment configuration.Thus, such embodiments may be configured such that some deploymentconfigurations may also be considered treatment configurations. Inalternative embodiments, the lysing tip may be reconfigured to rotate180 degrees allowing for angling of the tip in either direction relativeto the normal of the axis of the cannula. Thus, in this manner a lysingtip could be used to treat in a first lateral direction and also asecond lateral direction opposite to the first lateral direction such asin FIGS. 14b, 14k , and/or 14/L.

In the current embodiment, hinges 1427/1428 couple actuation rod pairs1421/1423 and 1422/1424 allowing a pivoting movement in both verticaldirections.

Some embodiments may utilize a protective sleeve 1499 which sleeve 1499may serve to protect the tip (either a lysing tip or tissue modificationtip (TMT)) during deployment such as those depicted in FIGS. 14k-n . Insome embodiments the protective sleeve 1499 may comprise a biodegradablematerial such as gelatin. Preferably the protective sleeve 1499 ispositioned about the distal end of the tip during deployment. Inembodiments in which the protective sleeve 1499 is biodegradable, thesleeve 1499 may begin to degrade once deployed in the body.Alternatively, the protective sleeve 1499 may not be biodegradable inwhich case the sleeve may be withdrawn from the tip by anotherinstrument. In some embodiments, the sleeve 1499 may be withdrawn bypositioning the sleeve covered tip within the body and then withdrawingthe tip to remove the sleeve. In other embodiments, the lysing tip 1410may be configured to rotate up to 180 degrees to a point to allow thesleeve to be withdrawn. In alternative embodiments, sleeve 1499 maycomprise a weakened seam 1499′ such that when lysing tip 1410 isrotated, the weakened seam 1499′ breaks allowing sleeve 1499 todisengage lysing tip 1410. For example, weakened seam 1499′ may comprisea series of cuts or scorings. In some embodiments, the sleeve 1499 maybe made up of a material configured to utilize body fluids to provide aslippery or non-frictional surface.

In the depicted embodiment, 1447 represents an antenna configured todeliver a signal to a receiver unit. Antennae 1447 may be located withinhole 1455. In some embodiments, antenna 1447 may comprise radiofrequencyidentification (RFID) TAG. In some embodiments the RFID tag may comprisean RFID transponder. In other embodiments the RFID tag may comprise apassive tag. It should be understood that antenna 1447 is not depictedin every one of the other figures; any of the embodiments describedherein may comprise one or more such elements. Other embodiments maycomprise one or more antenna on any other suitable location on theembodiment, including but not limited to on the protrusions or otherwiseon the tip, and on the shaft. In embodiments in which antenna 1447comprises an RFID transponder, the RFID transponder may comprise amicrochip, such as a microchip having a rewritable memory. In someembodiments, the tag may measure less than a few millimeters. In someembodiments a reader may generate an alternating electromagnetic fieldwhich activates the RFID transponder and data may be sent via frequencymodulation. In an embodiment, the position of the RFID tag or otherantenna may be determined by an alternating electromagnetic field in theultra-high frequency range. The position may be related to a 3dimensional mapping of the subject. In an embodiment the reader maygenerate an alternating electromagnetic field. In some such embodiments,the alternating electromagnetic field may be in the shortwave (13.56MHz) or UHF (865-869 MHz) frequency. Examples of potentially usefulsystems and methods for mapping/tracking a surgical instrument inrelation to a patient's body may be found in U.S. Patent ApplicationPublication No. 2007/0225550 titled “System and Method for 3-D Trackingof Surgical Instrument in Relation to Patient Body”, which is herebyincorporated by reference in its entirety.

In some embodiments, a transmission unit may be provided that maygenerate a high-frequency electromagnetic field configured to bereceived by an antenna of the RFID tag or another antenna. The antennamay be configured to create an inductive current from theelectromagnetic field. This current may activate a circuit of the tag,which may result in transmission of electromagnetic radiation from thetag. In some embodiments, this may be accomplished by modulation of thefield created by the transmission unit. The frequency of theelectromagnetic radiation emitted by the tag may be distinct from theradiation emitted from the transmission unit. In this manner, it may bepossible to identify and distinguish the two signals. In someembodiments, the frequency of the signal from the tag may lie within arange of the frequency of the radiation emitted from the transmissionunit. Additional details regarding RFID technology that may be useful inconnection with one or more embodiments discussed herein may be foundin, for example, U.S. Patent Application Publication No. 2009/0281419titled “System for Determining the Position of a Medical Instrument,”the entire contents of which are incorporated herein by specificreference.

In other embodiments, antenna 1447 may comprise a Bluetooth antenna. Insuch embodiments, multiple corresponding Bluetooth receivers at knownlocations may be configured to sense signal strengths from the Bluetoothantenna 1447 and triangulate such data in order to localize the signalfrom the Bluetooth antenna 1447 and thereby locate the lysing tip withina patient's body. Other embodiments may be configured to useangle-based, electronic localization techniques and equipment in orderto locate the antenna 1447. Some such embodiments may comprise use ofdirectional antennas, which may be useful to increase the accuracy ofthe localization. Still other embodiments may comprise use of othertypes of hardware and/or signals that may be useful for localization,such as WIFI and cellular signals, for example.

One or more receiver units may be set up to receive the signal from thetag. By evaluating, for example, the strength of the signal at variousreceiver units, the distances from the various receiver units may bedetermined. By so determining such distances, a precise location of thelysing tip relative to a patient and/or a particular organ or othersurgical site on the patient may be determined. In some embodiments, adisplay screen with appropriate software may be coupled with the RFID orother localization technology to allow a surgeon to visualize at leastan approximate location of the tag/antenna, and therefore the lysingtip, relative to the patient's body.

Some embodiments may be further configured such that data from theantenna(s) may be used in connection with sensor data from the device.For example, some embodiments comprising one or more sensors 1448 may befurther coupled with one or more RFID tags. One or more sensors 1448 maybe located within one or more holes 1455. As such, data from the one ormore sensors may be paired or otherwise used in connection with datafrom the one or more RFID tags or other antennas. For example, someembodiments may be configured to provide information to a surgeonregarding one or more locations on the body from which one or moresensor readings were obtained. In some embodiments, temperature sensorsmay include thermistors and/or thermocouples. To further illustrateusing another example, information regarding tissue temperature may becombined with a location from which such tissue temperature(s) weretaken. In this manner, a surgeon may be provided with specificinformation regarding which locations within a patient's body havealready been treated in an effective manner and thus which locationsneed not receive further treatment using the device.

In some such embodiments, a visual display may be provided comprising animage of the patient's body and/or one or more selected regions of apatient's body. Such a system may be configured so as to provide avisual indication for one or more regions within the image correspondingto regions of the patient's tissue that have been sufficiently treated.For example, a display of a patient's liver may change colors atlocations on the display that correspond with regions of the liver thathave experienced a sufficient degree of fibrosis or other treatment.Such regions may, in some embodiments, be configured such that pixelscorresponding to particular regions only light up after thecorresponding tissue in that region reaches a particular thresholdtemperature.

Such sensor 1448 may be coupled with an antenna, which may send and/orreceive one or more signals to/from a processing unit. Alternatively, oradditionally, data from such sensors resulting from tissue and/or fluidanalysis using such sensors may be stored locally and transmitted later.As yet another alternative, such a signal may be transmitted followingsurgery. In such implementations, the signals need not necessarily betransmitted wirelessly. In fact, some embodiments may be configured tostore data locally, after which a data module, such as a memory stick,may be removed from the device and uploaded to a separate computer foranalysis.

In alternative embodiments which may be helpful for skin/cosmeticprocedures, the TD tip and/or the anticipated and/or previous paths maybe visualized using for example an internal camera such as an endoscopicor laparoscopic camera, and/or an external camera such as an infraredcamera, (for example, a FLIR camera), an RFID tag or other antenna. Insome implementations, such a device or devices may be positioned on theTD. In other implementations such a device or devices may be separatefrom the TD. A real time display may be created using the data of thecameras and/or antennae and/or tags, for example, showing the exactlocation of the tip and the during- and post-passage temperatureeffects. In alternative embodiments, the software presenting the visualinformation may hold (or slow the decay back to the body temperature)the color (designating temperature) at its maximum value during theremainder of the procedure so that the surgeon will know where the TDtip has been.

In some embodiments, system 1400 may comprise canal(s) 1404 (onlydepicted in FIG. 14d ) which may be positioned to supply one or morefluids to the surgical site around or near lysing tip 1410 via a portlocated adjacent to the internal device cannula and/or lysing tip. Canal1404 may be configured to be extended and withdrawn as needed. Inalternative embodiments, other fluids that may pass down canal 1404 mayinclude, but not be limited to, cold nitrogen gas, fluorocarbons, etc.,which might cool and/or freeze tissue to alter it in a desired fashion.

FIGS. 4o-14t depict an example of a modular lysing tip 1410′ comprisinga treatment portion 1411′ of lysing tip and a reusable base portion1470L. Treatment portion 1411′, which may be disposable in someembodiments, is reversibly coupled with base portion 1470L. Thus, uponcompleting an electrosurgical procedure, the user may remove treatmentportion 1411′, and its accompanying lysing rod 1460 and beads 1451, frombase portion 1470L and reattach a new treatment portion for a subsequentsurgery.

In the depicted embodiment, treatment portion 1411′ may be coupled withbase portion 1470L aligning a seat 1470 u′ formed in upper supportmember 1470 u of treatment portion 1411′ with a locking portioncomprising a pair of opposing flanges 1470 f each of which comprises ahooked end portion 1470 h. Seat 1470 u′ in some embodiments may comprisea narrowed region of upper support member 1470 u. Thus, upon insertingseat 1470 u′ between opposing flanges 1470 f, hooked end portions 1470 hengage an upper surface of upper support member 1470 u in the region ofseat 1470 u′ as depicted in FIG. 14t . As best illustrated in FIG. 14r ,base portion 1470L may comprise a lower support member configured tomate with upper support member 1470 u such that together they define afull support member as previously described. In addition, because theupper support member 1470 u of treatment portion 1411′ will likely beused only once or otherwise less than base portion 1470L, preferably,holes 1472 and 1473 are formed in base portion 1470L. As previouslydescribed holes 1472 and 1473 may be used to facilitate coupling oflysing tip 1410′ with a deployment assembly as depicted in FIG. 14 o.

After performing an electrosurgical procedure using lysing tip 1410′,upper support member 1470 u may be removed from base portion 1470L by,for example, pulling seat 1470 u′ out of the locking portion of baseportion 1470L. In some cases, a user may pull or pry opposing flanges1470 f apart either by hand or by use of a suitable tool during thisdecoupling process. FIGS. 14p, 14s, and 14t are cross sectional viewstaken at line A-A depicted in FIG. 14 r.

FIGS. 15a-15k depict an alternative embodiment of a CDTD system 1500comprising beads 1551 a/b/c/d coupled with a bow/support member 1570 andfurther comprising an energy window made up of a plurality of electrodetermini 1506 a/1506 b/1506 c/1506 d for delivering energy such as RF.Bow/support member 1570 may be coupled to actuation arms 1521 and 1522and delivered through cannulas 1531 and 1532 may be employed. In someembodiments the RF energy delivered by the termini 1506 a/1506 b/1506c/1506 d may be distinct from the RF energy delivered by the lysingsegments between the adjacent beads. Beads may comprise facets 1552 andtunnels 1554. More particularly, in the depicted embodiment, the energywindow comprises an energy window strip 1507 which is preferably made ofa conductive material. Energy window strip 1507 comprises a plurality ofenergy window termini 1506 a/1506 b/1506 c/1506 d protruding from theenergy window strip 1507. An insulation cover 1508 may be configured tobe coupled with energy window strip 1507. In some embodiments insulationcover 1508 may be molded onto energy window strip 1507. Alternativelythe insulation cover 1508 may be configured to receive the energy windowstrip 1507 or otherwise be coupled with energy window strip 1507.Preferably, the insulation cover 1508 comprises a non-conductivematerial. In the depicted embodiments, the insulation cover 1508comprises an elongated base configured to cover the energy window stripbut allow the energy window termini 1506 a/1506 b/1506 c/1506 d toprotrude through the insulation cover 1508. In addition, the insulationcover 1508 comprises a plurality of protruding bead coupling members1508′, each of which is configured to extend into and be coupled withone of the beads of the tip via hole 1555 (as shown in FIG. 15i , across-sectional view down/through the center of outer bead 1551 d).Energy delivery conduit 1509 such as a wire may be coupled with theenergy window strip 1507. Preferably, the energy delivery conduit 1509is insulated from the energy delivery conduit that delivers energy tothe lysing segments 1561 a/1561 b/1561 c such that a distinct type ofenergy may be delivered therethrough.

In other embodiments, energy window may be configured to utilize energyof different modalities, including, but not limited to, laser, intensepulse light, resistive heating, radiant heat, thermochromic, ultrasound,mechanical, and/or microwave.

In some embodiments, system 1500 may be configured to utilize bipolarradiofrequency energy as depicted in FIGS. 15j (energy conduits notshown) and 15 k. In the depicted embodiment, each electrode termini maybe physically independent of the other, however, electrode termini pairs1506 a′/1506 c′ and 1506 b′/1506 d′ may each be electrically coupled toa positive energy conduit 1509 n and a negative energy conduit 1509 p,respectively. In some embodiments, the energy conduits may comprisewires.

FIGS. 16a-16h depict an alternative embodiment of a CDTD system 1600comprising a plurality of protrusions 1601 and recessions 1602positioned in between adjacent protrusions. System 1600 is structurallysimilar to system 1400, however, system 1600 is a bipolar device. System1600 further comprises first/inner/device cannula 1631 and second/outercannula 1632, the first or both which may be used to deliver lysing tip1610, as previously mentioned. System 1600 is configured for bipolarelectrosurgical energy delivery, has 3 protrusions defined by beadsouter beads 1651 a/1651 b and middle bead 1652, and 2 lysing segments1668 ps/1668 ns defined by two electrically isolated lysing members 1668pm/1668 nm.

In the embodiment of FIG. 16f , negative lysing member 1668 nm isconfigured to extend through a tunnel 1658 n formed in bead 1652.Similarly, positive lysing member 1668 pm is configured to extendthrough a separate tunnel 1658 p formed in 1652. Positive lysing member1668 pm and negative lysing member 1668 nm may extend from theirrespective tunnels all the way back to an electrosurgical generatorand/or surgical instrument. In other embodiments lysing members 1668pm/1668 nm may instead terminate within bead 1652 or may terminatesomewhere in between bead 1652 and its ultimate electrical coupling withan electrosurgical energy source. For example, in some embodiments, awire or another electrical conductor may be coupled to lysing members1668 pm/1668 nm.

In some such embodiments, the lysing tip comprises means for maintaininga flexible lysing member in a rigid state. Examples of such means mayinclude a weld, melt, crimp, bend, narrowing of tunnel, and the like. Ina more particular example of such a means, protuberance 1668 b may beformed adjacent to one or more of the openings of tunnel 1658 p or 1658n such that lysing members 1668 pm/1668 nm may be pulled through theirrespective tunnels and tightened or kept taught after whichprotuberances 1668 b may be formed to keep their respective lysingmembers in a rigid or substantially rigid state. In another embodiment,bead 1652 may be formed in two pieces and coupled together afterpositioning lysing members 1668 nm/1668 pm through their respectivetunnels. In some such embodiments, the tunnels may be formed at least inpart with a diameter equal to or less than that of lysing member 1668nm/1668 pm such that upon applying both pieces together the lysingmembers may be prevented from being withdrawn from their respectivetunnels.

In FIG. 16e , the wiring comprising lysing member 1668 p/1668 n has beenremoved in order to show the actuation rods 1621/1622 from the cannuladistally to the lysing tip 1610. Lysing tip 1610, more particularlystructural member 1670, in the delivery configuration, seats insidegroove 1621 a.

An external power cord may bring electrosurgical energy from anelectrosurgical generator to a hand assembly, such as that illustratedin FIG. 1, system 160, (which is electrically connected) to lysingmember 1668 pm/1668 nm (which may be insulated through cannula lumen)directly to lysing tip 1610. In this embodiment, each lysing member 1668pm/1668 nm enters its respective tunnel 1658 p/1658 n through the rearof center bead 1652, and exits an opposite side of bead 1652 whereinlysing member 1668 pm/1668 nm, preferably no longer be insulated afterexiting 1652, defines lysing segments 1668 ps/1668 ns whereupon eachenters its respective outer bead 1651 a/1651 b and terminates withinbeads 1651 a or 1651 b as previously described herein via coupling tips1663.

The tip shown in this embodiment has three relative protrusions 1601,lysing members 1668 pm/1668 nm (and associated lysing segments 1668ps/1668 ns), with beads 1651 a/1651 b/1652 pointing along the main axisof the CDTD in treatment configuration. In other embodiments, thebipolar CDTD lysing tip 1610 may have one or more non-axial protrusionsand one or more non-axial relative recessions. In some embodiments, thetip may have between 3 and 100 axial and/or non-axial protrusions and/orrelative recessions. It should be understood that the number ofprotrusions need not match the number of lysing elements or recessions.In some embodiments, lysing elements may be located at the termini ofconductive elements. In some embodiments, lysing elements may also bemade partially or completely of a cermet material. In an embodiment, themodular bipolar CDTD tip 1610 may measure about 15 mm in length (TL inFIG. 8e ) and/or about 3 mm in height (TH in FIG. 8d ). Embodiments arecontemplated wherein sizes of about one-fifth to about five times thesedimensions may have possible uses. It is also contemplated, for examplein some veterinary embodiments, tip sizes of about one-tenth to 20 timesthe aforementioned dimensions may have possible uses. In othercontemplated embodiments, electroconductive leads may course from anelectrosurgical generator via first/inner/device cannula 1631 toenergize various lysing elements located in bipolar CDTD tip 1610. Insome embodiments leads may comprise wires and/or conductive conduits.

FIG. 16g is an anterior elevated perspective view of lysing tip 1610. Inthis embodiment, individual lysing segments 1668 ps/1668 ns may comprisesurgical grade conductive metals and/or alloys positioned within alland/or a portion of one or more pieces of ceramic and/or other thermallyresistant, non-conductive housing. In some embodiments, one or moreindividual lysing elements/segments may comprise electroconductivematerials including but not limited to cermets, steel, nickel, alloys,palladium, gold, tungsten, titanium, silver, copper, and/or platinum. Inthe depicted embodiment, the lysing elements may measure about 2 mm inlength, and about 0.5 mm in diameter/thickness.

In this embodiment, the configuration of the tunnels in the end beadsmay capture corresponding elements as described in previous embodiments.For example, certain beads may comprise hole 1655 that may be positionedperpendicular to lysing rod hole 1658; holes 1655 may be available as aplatform/location to add other features/components such as providing alocation for coupling of a cord as described below in connection withother embodiments and/or locating a sensor and/or RFID locationcomponent and/or being used for placement of luminescent and/or lightproduction element(s) for visualization, for example, tritium and thelike.

In some contemplated embodiments there need not be equal numbers ofoppositely signed and/or charged individual lysing elements. Uniformityof flux on activation may be achieved by modifying the size and/orposition of lysing elements with respect to each other among othermethods known in the art.

The relative static permittivity of some ceramics may range from about 5to 10; this may cause some leakage of current in an undesirable pathbetween closely approximated opposing electrodes during activation. Useof other materials, for example, those having over of relative staticpermittivities of 5 may undesirably alter the resultant plasma field.The relative static permittivity of the intervening materials housingthe opposing electrodes may be enhanced by coating and/or surroundingand/or injection molding thermoresistant polymers of a low relativestatic permittivity into the housing and/or around one or more portionsof bipolar lysing segments 1668 ns/1668 ps to reduce the effectivestatic permittivity of the tip. In an embodiment, the thermoresistantpolymer of low relative static permittivity 2.1 may bepolytetrafluoroethylene. In other contemplated embodiments,thermoresistant polymers may include polyether etherketone (@3.3) and/orpolysulfone (@3.1) and the like may be useful.

In the depicted embodiments, the electrical insulator on lysing member1668 nm/1668 pm and/or support member 1670 may comprisepolytetrafluoroethylene. In other contemplated embodiments, theelectrical insulator may comprise an electrically nonconductive polymerwith a high melting temperature. In some embodiments, the nonconductivepolymer may comprise for example, polyether etherketone and/orpolysulfone, etc. In other contemplated embodiments, the electricalinsulator may comprise an electrically nonconductive and/or thermallynonconductive polymer.

In some embodiments and implementations, lysing tip 1610 may beconfigured such that its beads 1651 a/b and 1652 are too large to fitwithin the lumen of first/inner/device cannula 1631, even in thedelivery configuration. Thus, lysing tip 1610 in its deliveryconfiguration may be positioned just outside (immediately distal) offirst/inner/device cannula 1631 but within second/outer cannula 1632during delivery.

FIGS. 17a-17m depict yet another embodiment of a CDTD or a non-CDTDsystem 1700. System 1700 comprises a lysing tip 1710 that is configuredto be completely separable from any other element of the system. In thismanner as depicted in FIGS. 17f-g , lysing tip 1710 may be deliveredthrough a first/primary cannula 1732, which may comprise, for example, atrocar, and then coupled with a first surgical tool, such as agrasping/control instrument 1790 that can be used to control and/orenergize the lysing tip 1710 within the body of a patient during asurgical procedure. In some embodiments and implementations, a secondcannula may be used to deliver a second surgical tool, such as atransfer/grasping instrument 1796, that may be used to facilitatecoupling of lysing tip 1710 to the grasping/control instrument 1790,which instrument may be delivered through the same cannula 1732 throughwhich the lysing tip 1710 is delivered. In some embodiments,grasping/control instrument 1790 may have the same configuration asgrasping/transfer instrument 1796. In alternative embodiments,transfer/grasping instrument 1796 may be configured differently fromgrasping control instrument 1790 in that, for example, it may not havethe capability to transfer energy to lysing tip 1710 yet may have adifferent tip design in order to facilitate grasping/holding lysing tip1710 between two beads or other protrusions. Alternatively, the lysingtip 1710 may be delivered though a second unattached cannula 1735 alongwith a grasping/transfer instrument 1796 used to couple the lysing tip1710 to the first surgical tool delivered through the first/primarycannula, which other surgical tool may be used to control lysing tip1710 and perform the surgical procedure. As shown in the FIG. 17f ,lysing tip 1710 is positioned within outer cannula 1732 with an axisextending between the outermost beads 1751 a/1751 d in lysing tip 1710aligned with a primary axis of cannula 1732 and with a treatment side oflysing tip 1710 (opposite from grasping pad 1771) facing an internalsurface of cannula 1732.

In some implementations of methods using system 1700, the lysing tip maybe reconfigured from a delivery configuration to a treatmentconfiguration by delivering lysing tip 1710 through a cannula at leastsubstantially along a treatment axis of the lysing tip extending betweenopposing outer beads and then rotating the lysing tip once outside thedistal end of the cannula. In some such implementations the step ofreconfiguration the lysing tip from delivery to treatment configurationmay further comprise grasping a portion of the lysing tip such as thegrasping pad in a manner such that the treatment axis is at leastsubstantially perpendicular to an axis of the grasping instrument. Thus,the lysing tip may be grasped from a direction at least substantiallyperpendicular to the grasping direction in the treatment configurationduring delivery.

In alternative implementations, a standard 3-5 mm diameter graspinginstrument with handle (without a lysing tip attached) may be directedinto the body cavity, possibly via a trocar of accepting diameter or viaan incision in the skin, and exit extracorporeally via another trocar(for example, of larger diameter at umbilicus), whereupon the graspermay open its and receive the lysing tip at an angle that permits thegrasper to pull lysing tip into the body cavity through the largertrocar. Once inside the body cavity, the lysing tip may be reconfiguredfrom a delivery configuration to a treatment configuration.

Lysing tip 1710 may comprise a plurality of protrusions 1701 comprisingbeads 1751 and recessions 1702 between each bead pair. Lysing member1760, which in the depicted embodiment comprises a lysing rod 1760enclosed by spacers 1762 a/1762 b/1762 c positioned in recessions 1702,delivers electrosurgical energy. Each of the portions of lysing member1760 extending between adjacent beads 1751 may be considered lysingsegments 1760 a/1760 b/1760 c. In the depicted embodiment, each of thelysing segments or spacers 1762 a/1762 b/1762 c is collectively definedby a single lysing member 1760. However, other embodiments arecontemplated in which separate lysing members may be used for each ofthe lysing segments positioned between adjacent beads. FIG. 17c depictslysing tip 1710 with bead 1751 c removed in order to show internalcomponents and to show tunneling within outer beads 1751 a and 1751 d.

In FIG. 17j , spacers 1762 a/1762 b/1762 c may be removed and replacedwith protuberances 1765 a/1765 b positioned on opposing sides of one ormore of the beads, such as middle bead 1751 b, as a means to inhibit orlimit the lateral movement of middle bead 1751 b and/or any other beads,as desired. Additionally depicted in FIG. 17j is an embodiment in whichlysing rod 1760 is roughened or otherwise deformed between points 1767Land 1767R. In some such embodiments, this may be done by adding materialto the lysing rod and/or adding material to the inside of the beadtunnel 1754 in a manner that the diameter of sufficient portions oflysing rod 1760 is increased to or slightly greater the internaldiameter of tunnel 1754 of bead 1751 c such that when bead 1751 c isslid into its position between points 1767L and 1767R, bead 1751 c maytend to remain in place via friction fit. Alternatively, the portions oflysing rod 1760 configured to extend through bead tunnel 1754 may beroughened by removing material from lysing rod 1760 such as by sandingand/or blasting. In these configurations, lysing rod 1760 may also actas the lysing segments. In FIG. 17j . although both protuberances andfriction fit are shown and spacers removed, this is done primarily forpurposes of illustration, thus, as those of ordinary skill in the artwill appreciate, in practice, only one of the options may likely beused. The roughening described herein may be useful for example in orderto prevent or inhibit rotation of the beads on the lysing rod. In someembodiments, the amount of roughening may be used selectively to selectthe amount and/or ease of rotation.

In alternative embodiments, hole 1055 d′ may be moved to fully orpartially intersect tunnel 1054 thus allowing communication with lysingrod 1060; thus a weld, plug (for example 1055 p), glue, insert or othermethod of fixation may be inserted via hole 1055 d′ to attach to lysingrod 1060 thus restricting lateral movement of a bead. To reduce escapeof electrosurgical energy through hole 1055 d′, an insulator comprisedof epoxy, plastic, ceramic or the like may be placed in part or all ofthe remaining hole 1055 d′. This alternative embodiment may be appliedto other embodiments herein.

FIG. 17k illustrates a front/elevation view of an alternative embodimentin which lysing tip 1710 may be configured without a solid lysing rodand/or without spacers and/or welds (that may face distally, proximally,or therebetween) and the like. In such embodiments, internal beadtunnels 1754 and support member holes 1767 a/1767 b may be configured toaccommodate hollow lysing rod 1760 a. Between beads, hollow lysing rod1760 a may be deformed 1760 a′ in a manner to prevent lateral movementof beads and/or prevent rotation of beads, as shown in FIG. 17k . Hollowlysing rod 1760 a′ may be deformed minimally or to a point that it issubstantially flat. In such embodiments, it may be preferable for thefront edge to point distally as the leading front edge. In suchembodiments, screw 1709 may secure one or both ends of the hollow lysingrod 1760 a within outer beads 1751 a/1751 d. In alternative embodiments,hollow lysing rod 1760 a may be replaced with solid lysing rod 1760 anddeformed adjacent to middle beads in the manner suggested in thisparagraph. The configurations of this alternative embodiment may beavailable for any other similar embodiment contemplated herein.

In alternative embodiments that may comprise lysing rod 1760, spacers1762 a/b/c may be deformed on the lysing rod 1760 so as to becomeimmovable, either in addition to deforming the lysing rod itself or asan alternative to deforming the lysing rod.

As previously mentioned, beads 1751 may be coupled with one another byway of a single lysing member 1760 extending through tunnels 1754extending through each of the respective beads 1751. In the depictedembodiment, beads 1751 each comprise a non-symmetrical shape and/or maybe eccentric relative to tunnels 1754. However, in this embodiment, asshown in the figures, the opposing outer beads 1751 a and 1751 d have ashape that differs from the shape of the beads in between the outerbeads, namely beads 1751 b and 1751 c Of course, as previouslymentioned, in some embodiments, all of the beads may have the same, orsubstantially the same, shape/size. In other embodiments, each of thebeads may have a different shape to accommodate a particular type ofsurgery, for example. More particularly, beads 1751 b and 1751 c have asimilar distal or frontal shape (from the perspective of the treatmentside of tip 1710) but have a flattened, thus shorter, rear end so as toaccommodate a support member 1770, which in this embodiment comprises abow 1770. Support member, as described in greater detail below, may beused to facilitate temporary coupling of lysing tip 1710 to a surgicaltool, such as a driver. In some embodiments, support member 1770 mayalso be used to facilitate delivery of electrosurgical energy intolysing tip 1710. Support member 1770 may be preferably fully orpartially insulated, except for regions on which it is desired totransfer electrosurgical energy such as (1) at one or more surfaces ofgrasping pad 1771, (2) within the 2 distal support member holes (asshown in FIG. 17e, 1767a /1767 b), and/or (3) the opposing distal endsof support member 1770, in some cases distal of lysing rod 1760 in orderto deliver electrosurgical energy not only through lysing rod 1760 butalso through these distal ends of support member 1770. Support member1770 may be fully or partially insulated in order to preventelectrosurgical energy from transferring to tissue from the supportmember 1770; more particularly, insulating support member 1770 directselectrosurgical energy to lysing member 1760 through support memberholes 1767 a/1767 b. In some embodiments, support member 1770 maycomprise for example a non-conductive material such as a ceramic and/orflexible ceramics (for example, “Flexiramics®”). In some suchembodiments, one or more electrical conduits such as a wire may beembedded within and/or extend through or otherwise be coupled with thesupport member 1770 so as to deliver electrosurgical energy to lysingmember 1760.

Support member 1770 may be used to provide a frame or support structurefor lysing tip 1710 and/or used to provide a feature, such as graspingpad 1771. In the depicted embodiment, the grasping pad 1771 is definedin part by a tab 1771 a, to allow an endoscopic tool having a graspingtip, such as grasping tip jaws 1796 a/1796 b of grasping/controlinstrument 1790, to grasp and manipulate lysing tip 1710. If the tipends of support member 1770 are coated with nonconductive insulation,such coating might increase the width of relative protrusion 1701 andperform similar to a protrusion bluntly dissecting/separating tissues,however, if said tips are not so coated, the area of relative protrusion1701 may be limited to what is illustrated as said tip may perform in amanner similar to lysing rod 1760 cutting and/or coagulating tissues.

Support member 1770 in the current embodiment comprises a bow shapecomprising two opposing end tips comprising holes or other openingsthrough which lysing rod 1760 extends. The two tips of support member1770 may extend far enough distally to provide sufficient material toform the lysing rod through-holes. Alternatively, openings comprisingslots or the like may be formed at one or both of the two opposing tipsof support member 1770 if desired.

In the depicted embodiment, the tunnels 1754 are positioned in anon-central location within each of beads 1751. More particularly, thetunnels 1754 in this particular embodiment are positioned in a forwardor distal location relative to a central axis of each of beads 1751,including outer beads 1751 a and 1751 d, which may have a ellipsoidal orsimilar shape, and internal beads 1751 c and 1751 d, which may have asimilar ellipsoidal front tip but have a flattened and/or shortened rearend, as shown in the figures. As previously mentioned, this may bepreferable for some embodiments, particularly embodiments in which beads1751 can at least partially rotate on the lysing rod or other lysingmember 1760 to allow the lysing tip 1710 to be directed through tissuein a desired manner.

Preferably, the entire surfaces of the beads 1751, or at least outerbeads 1751 a and 1751 d, may be smooth. Or, at least all surfaces thatmay be expected to contact tissue during a surgical procedure may besmooth. For example, providing a smooth front end and a smooth trailingend may allow the lysing tip to be moved in a forward direction and thenin a rearward direction back and forth without catching an undesirableamount of tissue on beads to inhibit such movement. However, as shown inFIGS. 17a-17m , in some embodiments, the trailing end of some beads,such as internal beads 1751 b and 1751 c, may comprise a flat surfacesuch that each internal bead comprises a frusto-shaped or anothersimilar shape. In other contemplated embodiments, providing a roughtrailing end may create frictional drag on that portion of the bead thushelping reorient the front end of the bead for further tissue passage.Thus, in some embodiments, the trailing end may have a rougher surfacethan the front end. Preferably, at least the forward or distal surfaceof each bead is smooth and defines a substantially and/or partiallyellipsoidal shape or another shape having a smooth forward surface. Inalternative embodiments, the distal/forward tip of beads 1751 may have amore narrowed end to act more as a wedge for purposes of acting as ablunt dissector between tissues and tissue planes. The forward tips maybe narrowed by use of facets (such as those facets 1052 in FIG. 10d ).Facets are preferably formed on the distal/front/leading portions of thebead to facilitate tip movement through/between tissue layers. Asdescribed in FIGS. 12 aa-rr, a wide variety of alternative bead shapesare possible including, for example, ovoid shapes, spherical shapes,wheel shapes, bullet shapes or other shapes having a flat terminal end(such as, for example, frusto-ellipsoidal), wing shapes, etc. In someembodiments, beads may be faceted on the top, bottom, sides, frontand/or back such as illustrated in FIGS. 10c /10 d, at facet 1052.

As previously mentioned, in some embodiments, it may be desirable toallow beads 1751 to rotate, at least partially, on lysing member 1760.Thus, beads 1751 may not be fixed three-dimensionally with respect tolysing member 1760 and/or one or more other elements of lysing tip 1710.In some such embodiments, beads 1751 may be at least partially rotatablewith respect to the remainder of lysing tip 1710. In embodiments inwhich beads 1751 are rotatable in this manner, it may be desirable touse a lysing member having a circular cross section. It may also bedesirable to form spacers 1762 a/1762 b/1762 c in ways that facilitatesuch rotation and/or restrict it in some manner. Thus, in someembodiments, one or more of spacers 1762 a/b/c may also be rotatablewith respect to lysing member 1760. In some such embodiments, spacers1762 may be configured to rotate with beads 1751.

In the depicted embodiment, each of the spacers 1762 a/b/c is positionedabout one of the respective lysing segments defined by lysing member1760 which may be configured to space the various beads 1751 apart,provide stability to the lysing tip, and/or protect the respectivelysing segments (which, in the depicted embodiment, are collectivelydefined by a single lysing member 1760). Preferably, spacers 1762 a/b/ccomprise a conductive material, such as a suitable biocompatible metal,that can receive electrosurgical energy from the lysing member 1760 anddeliver it to various internal body tissues during a surgical procedure.Preferably, spacer(s) 1762 a/b/c are therefore in direct contact in oneor more pre-determined locations on lysing member 1760. In otherembodiments, a single spacer may both extend between the various beads1751 and extend through the tunnels through the beads 1751 rather thanusing separate spacers for each lysing segment.

One or more of the beads 1751, such as preferably one or both of theouter beads 1751 a and 1751 d, may further comprise a hole 1755. Hole(s)1755 may, together with a cord 1744 (which may be a suture), forexample, comprise an example of means for maintaining retrievability ofa free-floating lysing tip when the lysing tip is decoupled from agrasping/control instrument. In preferred embodiments and/orimplementations, cord 1744 or another loopable element may be loopedthrough one or more such hole(s) and then may extend through one or morecannulas used to deliver lysing tip 1710 proximally back to a surgeon.In this manner, in the event of a failure to grasp or otherwise couplelysing tip 1710 to a grasping/control instrument, such asgrasping/control instrument 1790, lysing tip 1710 may be retrieved fromwithin a patient's body by pulling on suture 1744 to retract lysing tip1710 though cannula 1732. In some embodiments, hole 1755 may also oralternatively be used to maintain position of lysing tip 1710 whileawaiting delivery of a grasping/control instrument 1790 for performingsurgical procedures. Upon properly coupling lysing tip 1710 with anappropriate tool for grasping and/or controlling lysing tip 1710, suchas grasping/control instrument 1790, a surgeon may cut suture 1744,preferably near a knot or other feature used to form a loop around hole1755. If a suture 1744 or other similar material/element is used that issufficiently flexible and non-disruptive, this shorter loop may beconfigured to be present during a surgical procedure using lysing tip1710 without unduly interfering with the procedure. In alternativeembodiments, holes 1755 may be available as a platform/location to addother features/components such as providing a location for coupling of acord as described below in connection with other embodiments and/orlocating a sensor and/or RFID location component and/or being used forplacement of luminescent and/or light production element(s) forvisualization, for example, tritium and the like. In alternativeembodiments, hole 1755′ may be moved to fully or partially intersecttunnel 1754 thus allowing communication with lysing rod 1760; thus aweld, plug, glue, insert or other method of fixation may be inserted viahole 1755′ to attach to lysing rod 1760 thus restricting lateralmovement of a bead and/or rotation of the bead with respect to lysingrod 1760. However, in some embodiments one or more of the beads alongwith the lysing rod 1760 may be configured to rotate at least partiallywith respect to the support member 1770. To reduce escape ofelectrosurgical energy through hole 1755′, an insulator comprised ofepoxy, plastic, ceramic or the like may be placed in part or all of theremaining hole 1755′. This alternative embodiment may be applied toother embodiments herein.

Preferably, lysing member 1760 terminates within outer beads 1751 a and1751 d. Thus, it may be desirable to melt, tip, ball, crimp, fold, tie,or otherwise couple the ends of lysing member 1760 within outer beads1751 a and 1751 d at opposing lysing member coupling tips 1763 a and1763 b. Preferably, lysing tip 1710 is configured such that each ofbeads 1751 are rotatable independent of one another. However, dependingupon how opposing lysing member coupling tips 1763 a and 1763 b areconfigured, rotation of outer bead 1751 a may transfer, at least to acertain extent, to outer bead 1751 d, and vice versa.

In some embodiments, it may be desirable to provide features and/orelements that inhibit or limit the ability of the electrosurgical energyto discharge from the opposing ends of the lysing rod 1760 at couplingtips 1763 a/b. Thus, in some such embodiments, coupling tips 1763 a/bmay be coated or covered with a suitable insulating material such as anepoxy with non-conductive properties. Alternatively, outer bead hole1754 at the end with the larger-opening may be capped or plugged with anelement configured to be received or otherwise engage the larger openingof the bead. Preferably, this element will have non-conductiveproperties similar to the insulating material previously referenced.

Coupling tip 1763 a/1763 b may be configured to engage a ledge 1759positioned at a transition point between two concentric tunnels (1759a/1759 b), more particularly, outer tunnel 1759 b may comprise a largerdiameter or other cross-sectional dimension than inner tunnel 1759 asuch that lysing member 1760 may extend through inner tunnel 1759 a butcoupling tip 1763 a due to its larger size may be configured to extendthrough outer tunnel 1759 b without passing through inner tunnel 1759 a.In other embodiments, there may be a single tunnel 1759 c that tapersfrom a larger dimension on the outer side of bead 1751 to a smallerdimension toward the inside of the bead relative to the lysing tip 1710.

As shown in FIG. 17a , grasping pad 1771 of support member 1770 may besituated along a central portion of support member 1770 along the rearor proximal end of lysing tip 1710. In some embodiments, grasping pad1771 may comprise a plate with opposing flattened surfaces configured toallow a surgical tool with a grasping tip, such as jaws 1796 a and 1796b in FIGS. 17f and 17g , to grasp and/or manipulate/control supportmember 1770 and therefore lysing tip 1710.

In some embodiments, at least a portion of support member 1770 and/orgrasping pad 1771 may comprise a conductive material and support member1770 and/or grasping pad 1771 may be configured to receiveelectrosurgical energy, such as from a grasping/control instrument 1790or another surgical tool, and deliver such energy to lysing member 1760.For example, in some such embodiments, electrosurgical energy may bedelivered through grasping jaws 1793 a/1793 b, into grasping pad 1771,down through the frame of support member 1770, and into lysing member1760. In other embodiments, grasping pad 1771 may be insulated andelectrosurgical energy may instead be delivered to lysing tip 1710 inanother manner.

FIGS. 17a-e illustrate a tab 1771 a extending distal from grasping pad1771, which comprises an extended central region. Such central regionmay be useful to allow for greater surface area for grasping by jaws orother elements of a grasping tip from a surgical tool, such as jaws 1796a/1796 b of grasping/control instrument 1790.

In embodiments comprising a free-floating lysing tip (can be uncoupledfrom any control instrument or cannula), including the embodiments ofFIGS. 17-31 and 35-38, certain preferred embodiments may have a size ofabout 12 to 18 mm from the end of one protrusion and/or bead to theopposite protrusion/bead on the opposite end; the length of the largestouter beads (BL as illustrated in FIGS. 8d /8 e) may range from about 3mm to 12 mm; the height BH as illustrated in FIGS. 8d /8 e) of thelargest outer beads may range from 2 mm to 10 mm. In some embodiments,this dimension may be defined by the distance from the upper end of oneor more (in some embodiments, each) beads to the lower end of one ormore beads. In some free-floating embodiments, the lysing tip may have awidth TW as illustrated in FIGS. 8d /8 e) of about 4.5 mm from theproximal end of the lysing tip to the distal end of the lysing tip.However, it should be understood that a wide variety of alternativeshapes and/or sizes may be usable depending upon the particular surgicalprocedure involved.

Similarly, in embodiments comprising a fixed lysing tip (coupled to oneor more actuation rods), certain preferred embodiments may have a sizeof about 15 mm from the end of one protrusion and/or bead to theopposite protrusion/bead on the opposite end, may have a size of about 3mm from the upper end of the lysing tip to the lower end of the lysingtip. In some embodiments, this dimension may be defined by the distancefrom the upper end of one or more (in some embodiments, each)protrusions/beads to the lower end of one or more protrusions/beads. Insome free-floating embodiments, the lysing tip may have a size of about3.5 mm from the proximal end of the lysing tip to the distal end of thelysing tip. However, it should be understood that a wide variety ofalternative shapes and/or sizes may be usable depending upon theparticular surgical procedure involved.

In FIGS. 17h-i , a non-conductive sheath 1795 may be deployed to coverthe outer surface and/or conductive surfaces of shaft and tip/jaws 1793a/1793 b of grasping/control instrument 1790 to electrically isolate theelectrically conductive surfaces of grasping/control instrument 1790. Inthe current embodiment, conducting wire 1768 may carry electrosurgicalenergy from the energy source to lysing tip 1710. In other embodiments,the embodiment of FIG. 17h /17 i may also have an insulated grasping pad1771, since wire 1768 is provided for delivery of electrosurgicalenergy. In other contemplated embodiments, sheath 1795 may electricallyisolate the grasping control instrument, but permit electrical contactbetween the jaws of grasping control instrument 1790 and the graspingplate of lysing tip 1710. However, it should be understood that theshape of grasping pad 1771 may be used in conductive or non-insulatedembodiments.

FIG. 17b is a cross-sectional view taken along line 17 b-17 b in FIG.17a illustrating spacer 1762 b, middle bead, 1751 b, support member1770, and lysing rod 1760. FIG. 17e is a perspective view of supportmember 1770 (and grasping pad 1771) comprising holes 1767 a/1767 bthrough which lysing rod 1760 extends and comprises coupling tips 1763a/1763 b on its opposing ends.

An alternative system for use of a lysing tip 1714 t with a modulargrasping instrument tip 1714 g is shown in FIGS. 17L and 17 m. In someembodiments, modular instrument tip 1714 g and lysing tip 1714 t may bepermanently coupled to one another as described below. Alternatively, inother embodiments lysing tip 1714 t may be removable from modularinstrument tip 1714 g. When the instrument tip 1714 g and lysing tip1714 t may be combined, they may be referred to herein as a modulargrasper/tip 1714. Modular instrument tip 1714 g comprises a lockinglumen 1797′ that is configured to be coupled with a distal end of apushrod 1797 and shaft 1796 of a modular grasping/control instrument 90.

In an example of a procedure using the system of FIG. 17L, a surgeon mayinitially place a trocar 1732′ at a desired location such as through anincision 6′ positioned through the umbilicus 5. A second incision 6,which may be a smaller incision than incision 6′, may be made at alocation spaced apart from incision 6′. In some embodiments andimplementations, incision 6 may be between about 2.5 and about 5 mm.Shaft 1796 of instrument 90 may then be extended through incision 6 andthen subsequently through incision 6′ and trocar 1732′. Modular graspinginstrument 1714 g may then be coupled with the distal end of shaft 1796and push rod 1797. Once lysing tip 1714 t is coupled with modulargrasping instrument tip 1714 g, instrument 90 may then be pulledproximally to introduce lysing tip 1714 t within patient 4. Inembodiments in which lysing tip 1714 t is removable from modulargrasping instrument tip 1714 g, lysing tip 1714 t may be coupled withthe distal end of instrument tip 1714 g prior to proximally pullinginstrument 90 and its distal tip back into the cavity of human or animalbody 4. Once modular instrument tip 1714 g has been coupled withinstrument 90, handle 91 may be used to control one or more aspects oflysing tip 1714 t. For example, actuation of handle 91 may result inlocking lysing tip 1714 t at a particular rotational orientationrelative to shaft 1796 as described in connection with FIG. 17M.Alternatively, handle 91 or another actuation element of instrument 90may be used to rotate lysing tip 1714 t between delivery and treatmentconfigurations. Instrument 90 may also be used to deliverelectrosurgical energy to lysing tip 1714 t. For example, as shown inFIG. 17L, energy connector 92 which may comprise a conductive post maybe used to facilitate an electrical connection with an electrosurgicalgenerator. The electrosurgical energy from this generator may extendthrough shaft 1796 via pushrod 1797 and be coupled with one or morelysing members of lysing tip 1714 t as previously described.

FIG. 17M depicts a more detailed view of the interface between modulargrasping instrument 1714 g and distal tip of shaft 1796 and pushrod 1797of instrument 90. As shown in this figure the distal end of shaft 1796may comprise a locking feature 1798. Locking lumen 1799′ within modularinstrument tip shaft 1794 comprises a slot 1799 s configured to receivelocking feature 1798 at a predetermined rotational configuration. Uponaligning locking feature 1798 with slot 1799 s, shaft 1796 and pushrod1797 may be advanced into locking lumen 1797′. After advancing shaftlocking feature 1798 to its terminal end 1798′ within coupling rod 1792,upon rotation 2 of modular instrument tip shaft 1794, locking feature1798 securely couples shaft 1796 to coupling rod 1792. During the sametime period, pushrod 1797 and its accompanying pushrod locking feature1799 n was advanced to a locking chamber 1799 n′ in which pushrod 1797and its accompanying pushrod locking feature 1799 n may have beenrotated to lock pushrod locking feature 1799 n in place within lockingchamber 1799 n′. In some embodiments, the extent of the rotation ofpushrod locking feature 1799 n may be the same as the extent of rotationof locking feature 1798 which may in some embodiments be 90 degrees. Insome embodiments, pushrod locking feature 1799 n may comprise a plate oran elongated box or any other feature not having rotational symmetryabout the axis pushrod 1797. Locking chamber 1799 n′ may comprise forexample a box or other similar feature given to engage pushrod lockingfeature 1799 n upon rotation of pushrod 1797.

Locking chamber 1799 n′ is coupled with coupling rod 1792 which in turnmay be coupled with one or both jaws. Thus, upon advancing or retractingpushrod 1797, coupling rod 1792 advances or retracts to open or closethe jaws so as to capture support member 1770 within jaws 1793 a (notshown)/1793 b.

Any of the preliminary steps for coupling a lysing tip with aninstrument and/or inserting the lysing tip into a patient discussed inconnection with FIGS. 17L and 17 m may be performed in connection withany of the surgical methods described in connection with FIGS. 40-50.

FIGS. 18a-18e depict another embodiment of a CDTD system or a non-CDTDsystem. Although, other embodiments are contemplated in which system1800 may comprise a CDTD system. System 1800 comprises a lysing tip 1810that is configured to be completely separable from any other element ofthe system. Lysing tip 1810 may comprise a plurality of protrusions 1801comprising beads 1851 a-d and recessions 1802 between each bead pair.Lysing member 1860, which in the depicted embodiment comprises a lysingrod 1860, is enclosed or may be partially enclosed by spacers 1862a/1862 b/1862 c positioned in recessions 1802, delivers electrosurgicalenergy. Each of the portions of lysing member 1860 extending betweenadjacent beads 1851 may be considered lysing segments as discussedpreviously herein. In the depicted embodiment, each of the lysingsegments or spacers 1862 a/b/c is collectively defined by a singlelysing member 1860. However, other embodiments are contemplated in whichseparate lysing members may be used for each of the lysing segmentspositioned between adjacent beads. Spacers may be configured and/orattached as described and illustrated in FIGS. 18a-18e to immovably fixspacers 1862 a/b/c on a lysing rod 1860.

Spacers 1862 a/1862 b/1862 c may be coupled with lysing rod 1860 by, forexample, sliding spacers 1862 a/b/c comprising a lumen along the axis oflysing rod 1860. Alternatively, spacers 1862 a/b/c may be coupled withlysing rod 1860 by placing spacers 1862 a/b/c over lysing rod 1860 in adirection perpendicular to the axis of the lysing rod at a desiredlocation using a slot or other opening formed along a portion of aperimeter spacer 1862 a/b/c. In some embodiments and implementations,spacers 1862 a/b/c (two of a potential three shown in FIG. 18c ) may becrimped or otherwise fixedly coupled with lysing rod 1860 at a desiredlocation. In some embodiments, this fixed coupling may be configured toprevent the relative movement between lysing rod 1860 and spacer 1862a/b/c possibly reducing hot spots caused from high current density flowin certain areas between lysing rod 1860 and spacer 1862 a/b/c. Theseexemplary methods for applying spacers to a lysing rod and/or anotherlysing member may be apply to any of the other embodiments utilizingspacers.

In some contemplated embodiments spacers may be comprised of insulatingmaterials (such as ceramic, glass, plastic and the like) that may haveholes and/or be porous and/or have breaks and/or have separations suchthat energy from lysing member(s) within may be released into targettissues to have effect such as that illustrated in FIG. 12 j.

In some such embodiments, beads 1851 may be at least partially rotatablewith respect to the entire lysing tip 1810. In embodiments in whichbeads 1851 are rotatable in this manner, it may be desirable to use alysing rod having a circular cross section. It may also be desirable toeither omit spacers 1862 a/b/c or form them without the beveled edgesbest shown in FIGS. 12h, 12n , etc.

Spacers 1862 a/b/c may be used to prevent rotation of beads 1851 or toselectively limit the amount of rotation of beads 1851 on a lysingmember 1860. For example, if spacers 1862 a/b/c extend the entiredistance or at least substantially the entire distance between eachadjacent bead, spacers may prevent rotation or, depending upon thedistance between spacers and adjacent beads, may be used to allow for apredetermined amount of such rotation. Similarly, the opposing ends ofspacers 1862 a/b/c may be shaped to match or at least substantiallymatch the shape of the adjacent bead(s) again to either prevent orcontrol rotation.

System 1800 differs from system 1700 only in the manner as to how lysingtip 1810, specifically at grasping plate 1871, is grasped bygrasping/control instrument 1890. Specifically, in FIGS. 18a-e , thegrasping/control instrument 1890 comprises a tip with upper jaw 1893 aand lower jaw 1893 b, configured in such a manner to create, when shut,a receiving slot 1897 into which the grasping pad 1871 of support member1870 may be grasped. The dimensions of the receiving slot 1897, such asthe width and/or height of receiving slot 1897 may correspond with thedimensions of the support member 1870 at its grasping pad 1871 such thatthere will be a rigid coupling between the jaws and support memberduring the surgical procedure. FIG. 18d illustrates ledge 1859 withinbead 1851 which may engage coupling tips positioned on opposing ends oflysing rod 1860. Support member 1870 may be preferably insulated, exceptwithin its holes, to prevent unwanted delivery of electrosurgical energyto tissues; thus, electrosurgical energy is directed to support memberholes at which lysing rod 1860 becomes energized for energy delivery.

In this embodiment, facets 1852 may be positioned at the distal ends ofthe beads and the configuration of the tunnels in the end beads maycapture corresponding elements as described in previous embodiments. Forexample, certain beads may comprise hole 1855 that may be positionedperpendicular to lysing rod hole 1858; holes 1855 may be available as aplatform/location to add other features/embodiments (for example,antennae 1847 and/or sensor 1848) and/or to be used for cord/sutureattachments for lysing tip manipulation and/or removal and/or be usedfor placement of luminescent and/or light production for visualization,for example, tritium and the like.

This description is intended to apply to holes in other embodimentsherein similar to 1855.

In FIGS. 19a-d , an alternative structure for the support member 1970 oflysing tip 1910 is depicted, however, all other features of theembodiments depicted in all FIG. 17 and FIG. 18 may be the same inregards to or may apply to the embodiment depicted in FIG. 19. In FIG.19, support member 1970 comprises a gasping pad 1971 with tab 1971 a,however, in the depicted embodiment, grasping pad 1971 comprises anopening 1973 which may be either a blind hole or a through-hole. Opening1973 may be configured to receive a corresponding projection 1996 aformed on one or both of jaws of the tip of a grasping/controlinstrument, such as that in FIG. 19b , jaws 1993 a/1993 b, to facilitatea secure coupling during the surgical procedure. In addition,corresponding projection 1996 a may be used to deliver energy fromgrasping/control instrument 1993 directly to the opening 1973 of supportmember 1970 which may be especially beneficial if jaws 1993 a/1993 b andgrasping pad 1971 are coated with non-conductive insulation andprojection 1996 a and the tunnel of opening 1973 are not so coated witha non-conductive coating. Thus, in some embodiments projection 1996 amay comprise a conductive, uncoated projection protruding from coatedjaws.

In FIGS. 19c and 19d , an alternative embodiment of a non-CDTD system isillustrated comprising inner beads 1951 i and outer beads 19510 coupledwith a bow/support member 1970 and further comprising an energy windowmade up of a plurality of electrode termini 1906 for delivering energysuch as RF. This embodiment is similar to that depicted in FIG. 15a-k .In some embodiments the RF energy delivered by the termini 1906 may bedistinct from the RF energy delivered by the lysing segments between theadjacent beads. More particularly, in the depicted embodiment, theenergy window comprises an energy window strip 1907 which is preferablymade of a conductive material. Energy window strip 1907 comprises aplurality of energy window termini 1906 protruding from the energywindow strip 1907. An insulation cover 1908 may be configured to becoupled with energy window strip 1907. In some embodiments insulationcover 1908 may be molded onto energy window strip 1907. Alternativelythe insulation cover 1908 may be configured to receive the energy windowstrip 1907 or otherwise be coupled with energy window strip 1907.Preferably, the insulation cover 1908 comprises a non-conductivematerial. In the depicted embodiments, the insulation cover 1908comprises an elongated base configured to cover the energy window stripbut allow the energy window termini 1906 to protrude through theinsulation cover 1908. In addition, the insulation cover 1908 comprisesa plurality of protruding bead coupling members (not shown here, but asdepicted in FIGS. 15h , bead coupling member 1508′), each of which isconfigured to extend into and be coupled with one of the beads of thetip via hole 1955 o (as shown in FIG. 15i , a cross-sectional viewdown/through the center of outer bead 1551 d). Energy delivery conduit1909 such as a wire may be coupled with the energy window strip 1907.Preferably, the energy delivery conduit 1909 is insulated from theenergy delivery conduit that delivers energy to the lysing segments suchthat a distinct type of energy may be delivered therethrough.

In other embodiments, the energy windows may be configured to utilizeenergy of different modalities, including, but not limited to, laser,intense pulse light, resistive heating, radiant heat, thermochromic,ultrasound, mechanical, and/or microwave.

In alternative embodiments, the energy window strip 1907 may beconfigured to be positioned on the bottom of the device, thus mounted onthe bottom of beads 1951 i/1951 o. However, in various implementations,a surgeon may simply invert the tip of a top-mounted energy strip 1907so that it points in the opposite direction (for example, away from thesurface skin and toward the subcutaneous tissues. Thisinward/subcutaneous direction of energy may be useful in directingenergy toward the subcutaneous deposits in cellulite and other cosmeticconditions.

FIGS. 20a-20o depict another embodiment of a CDTD or non-CDTD system2000. System 2000 comprises protrusions 1001 and recessions 2002 formed.System 2000 comprises a lysing tip 2010 that is configured to becompletely separable from any other element of the system, however,lysing tip 2010 is configured to work in conjunction with thesubstantially ellipsoidal-shape at the distal end of jaws 2093 a/2093 bof grasping/control instrument 2090, as this preferably insulated shapemay serve the same functions as beads 2051 a/2051 b as previouslydiscussed. Lysing tip 2010 comprises two beads 2051 a/2051 b positionedat opposite end of lysing member 2060. In the depicted embodiment,lysing member 2060 comprises plate 2060 which may comprise grasping pad2071. Upon being grasped by grasping/control instrument 2090 to performa surgical procedure, the distal tip 2093 of grasping/control instrument2090 substantially mimics the shape and/or function of beads 2051 a/2051b such that two lysing segments are defined on opposite ends between tip2093 and bead 2051 a on one side and between tip 2093 and bead 2051 b onthe other. In some embodiments, the portion of distal tip 2093 extendingonto or beyond lysing plate 2060 may have an identical or at leastsimilar distal shape and size to beads 2051 a/2051 b. For example, thisportion of distal tip 2093 may have rounded/smooth surfaces that tapertowards a rounded tip similar to beads. At the very least, it ispreferred that distal tip 2093 be shaped and sized such that lysingplate 2060 can come in contact with or near contact with target tissues.Together, the beads 2051 a/2051 b and distal tip 2093 may function asblunt dissectors to separate tissues without cutting. While the deviceis energized with electrosurgical energy, beads 2051 a/2051 b and outersurface distal tip 2093 are preferably non-conductive in order toperform the blunt dissection function. The inside of jaws 2093 a and/orits corresponding lower jaw 2093 b define a receiving slot 2097 and oneor both may be electrically conductive in order to permitelectrosurgical energy to flow to the lysing plate 2060.

System 2000 is configured to prevent or limit lateral movement of outerbeads 2051 by fixing bead holes 2053 a/2053 b in outer beads 2051 a/2051b and corresponding lysing plate holes 2066 a/2066 b through which aresulting substantially solid object like a pin or glue may be insertedto effectively couple the beads 2051 to the lysing plate 2060. Inalternative embodiments, lysing plate holes 2066 a/2066 b may bereplaced with grooves that may receive the solid object(s) insertedthrough fixing bead holes 2053.

In alternative embodiments, the dimensions of plate 2060 may be reducedto approach the width and/or thickness of previously described lysingrods. In such embodiments, the corresponding tunnel in outer beads 2051a′/b′ may be appropriately reduced to match corresponding dimensionsand/or the corresponding grooves and in one or more of the jaws 2093a′/2093 b′ of the grasping instrument may similarly be modified to matchthat of at least a portion of rod 2060′. In alternative embodiments asshown in FIG. 20o , upper jaw 2093 a″ may consist of a front portionthat overhangs truncated lower jaw 2093 b″, thus reducing thepossibility of tissue entry on forward motion. In other embodiments, theoverhang may encompass a larger portion of the opposite jaw. In thisdepicted embodiment, jaws 2093 a″/2093 b″ are configured such thatdespite the previously described overhang of upper jaw 2093 a″, when thejaws are in a closed configuration, the distal portion of the instrument2090′ substantially mimics the shape about the distal portions of thebeads about the distal portion of the instrument 2090′.

In some embodiments, lysing member 2060′ comprises a rigid and/orsubstantially rigid wire as shown in FIGS. 20i-20o . In suchembodiments, one or both of jaws 2093 a″ and 2093 b″ may comprise a slotconfigured to receive the rigid wire/lysing rod 2060′. This slot 2097′may be configured so as to tightly receive lysing rod 2060′ so as toprevent or at least inhibit rotation of lysing tip 2010′. Alternatively,slot 2097′ may either be slightly larger than the diameter of lysing rod2060′ or may be configured to allow a user to adjust the size of slot2097′ by actuating one or both of jaws 2093 a′/2093 b′ such that theuser can provide for a desired amount of rotation corresponding with theforce delivered to jaws 2093 a′/2093 b′. As previously mentioned, otherfeatures may be included to limit or selectively allow for rotation suchas welds and/or spacers (for example, spacer 2062′ extending from insideeach outer bead or spacer 2062″ coupled to lysing rod 2060′ extendingfrom side of outer bead to side of grasping jaw 2093 a″/b″). Forexample, in some embodiments, spacers may be positioned adjacent toopposing outer beads 2051 a′/b′ such that jaw 2093 a′/b′ may grip lysingrod 2070′ in between the two spacers. Such spacers may be used to eitherinhibit or selectively limit rotation by, for example, their shape,and/or proximity to jaws 2093 a′/b′. In this embodiment, a surgeon maybe able to dissect on one or more of the sides on the backstroke,possibly making surgery more efficient. In some preferred embodimentsand implementations, allowing for reverse dissection, it may bepreferable to either loosen the grip of the lysing rod or otherwiseprovide for a coupling between the jaws that is loose enough allow forrotation the lysing rod within the jaws. Alternatively, a rigid couplingbetween the lysing rod and the jaws may be provided and instead thebeads may be configured to rotate about the lysing rod such that thedistal ends of the beads become the proximal ends when the lysing tip isbeing reversed.

In alternative embodiments, lysing rod 2060′ may not be end capped atthe exact outermost portions of its tips. Instead any number of holes2055′ may be made at any number of angles to intersect the lysing rod2060′ and/or its tunnel 2054 or 2054′ to deposit a material thatrestrains the lysing rod within the bead 2051 a′/b′ (for example,materials may include welds, glues, epoxies, plugs (2055 p), and thelike). In such embodiments, tunnel 2054′ may be a blind tunnel notrequiring full passage through bead 2051 a′/b′ as bead may befixed/restrained internally. See for example FIGS. 20 j/k showing sideviews of beads 2051′ and 2051″. FIG. 20k shows full passage of tunnel2054 which intersects with hole 2055′ (illustrated with dashed linesdesignating hole 2055′ being internal to bead 2051′). FIG. 2jillustrates tunnel 2054′ which intersects with hole 2055′ (illustratedwith dashed lines designating hole 2055′ being internal to bead 2051′)not extending to the outside of outer bead 2051″ (illustrated withdashed lines). This alternative embodiment may be applied to otherembodiments herein. In alternative embodiments, beads 2051 a′/b′ may bereplaced with beads of any shape, including but not limited to thosedepicted in FIGS. 12 aa to 12 rr. In some embodiments wherein a spaceris positioned between a lysing rod and grasper jaws, the tolerancebetween the lysing rod and a spacer may allow for rotation of the lysingrod within the spacer and thus allow for rotation of beads with respectto a spacer and/or grasper. The tolerance may be adjusted to allow for apredetermined amount of rotation.

In the embodiment illustrated in FIGS. 21a-e , the lysing tip 2110comprises grasping plate 2161, lysing rod 2160, and beads 2151 a/2151 b.In this embodiment the inner surfaces of upper jaw 2193 a and lower jaw2193 b (of grasping/control instrument 2190) are configured to match orsubstantially match the upper and lower surfaces of grasping plate 2161in the closed configuration (thus creating receiving slot 2197). Thelysing rod 2160 may be permanently or temporarily coupled to graspingplate 2161 for example by weld, and/or by snap-fit between the distalend of the grasping plate 2161 and the center/proximal portion of lysingrod 2160. In the depicted embodiment, the width of the grasping platetapers from a narrowed portion of the distal end to a widened portion ofthe proximal end which tapering may mimic or substantially mimic similartapering of the corresponding jaw 2193 a/2193 b. The length of graspingplate 2161 may be similar to or identical to the length of one or bothjaws 2193 a/2193 b. In some embodiments, the outer surfaces of jaws 2193a/2193 b may be surface-coated with a non-conductive dielectric coating.

Lysing tip 2110 may comprise a plurality of protrusions 2101 comprisingdistal portions of beads 2151 and recessions 2102 between each beadpair. The portions of lysing member 2160 extending between adjacentbeads 2151 a/2151 b may be considered the lysing segment.

As previously mentioned, beads 2151 may be coupled with one another byway of a single lysing member 2160 extending through tunnels 2154extending through each of the respective beads 2151. In the depictedembodiment, beads 2151 each comprise a non-symmetrical shape and/or maybe eccentric relative to tunnels 2154. More particularly, tunnels 2154are positioned distally of a central portion of beads 2151 such thatthere is more material proximally of tunnels 2154 than distally. Beads2151 a and 2151 b have a similar distal or frontal shape (from theperspective of the treatment side of tip 2110) but have a flattened,thus shorter (from the elongated-axis perspective), rear end 2153 a. Inother embodiments, beads may have a greater elongated-axis dimension.

As previously mentioned, this may be preferable for some embodiments,particularly embodiments in which beads 2151 can at least partiallyrotate on the lysing rod or other lysing member 2160 to allow the lysingtip 2110 to be directed through tissue in a desired manner. In somecontemplated embodiments, beads may be symmetrical.

Preferably, the entire surfaces of the beads 2151, or at least outerbeads 2151 a and 2151 b, may be smooth or at least substantially smooth.Or, at least all surfaces that may be expected to contact tissue duringa surgical procedure may be substantially smooth. For example, providinga smooth front end and a smooth trailing end may allow the lysing tip tobe moved in a forward direction and then in a rearward direction backand forth without catching an undesirable amount of tissue on beads toinhibit such movement. As shown, in some embodiments, the trailing endof some beads, such as beads 2151 a and 2151 b, may comprise a flatsurface such that each bead comprises a frusto shape or another similarshape. Preferably, at least the forward or distal surface of each beadis substantially smooth and defines an ellipsoidal shape or anothershape having a substantially smooth forward surface. In the depictedembodiment, beads surfaces may have facets 2152.

In other contemplated embodiments, providing a rough trailing end maycreate frictional drag on that portion of the bead thus helping reorientthe front end of the bead for further tissue passage. Thus, in someembodiments, the trailing end may have a rougher surface than the frontend

As previously mentioned, in some embodiments, it may be desirable toallow beads 2151 to rotate, at least partially, on lysing member 2160.Thus, beads 2151 may not be fixed three-dimensionally with respect tolysing member 2160 and/or one or more other elements of lysing tip 2110.In some such embodiments, beads 2151 may be at least partially rotatablewith respect to the remainder of lysing tip 2110. In embodiments inwhich beads 2151 are rotatable in this manner, it may be desirable touse a lysing member having a circular cross section.

Preferably, lysing member 2160 terminates within outer beads 2151 a and2151 b. Thus, it may be desirable to melt, tip, ball, crimp, fold, tie,or otherwise couple the ends of lysing member 2160 within outer beads2151 a and 2151 b at opposing lysing member coupling tips 2163 a and2163 b. Preferably, lysing tip 2110 is configured such that each ofbeads 2151 is rotatable independent of one another.

Coupling tip 2163 a/b may be configured to engage a ledge positioned ata transition point between two concentric tunnels (2159 a/2159 b)(similar to that depicted in FIG. 17c at tunnels 1759 a/1759 b). Moreparticularly, outer tunnel 2159 b may comprise a larger diameter orother cross-sectional dimension than inner tunnel 2159 a such thatlysing member 2160 may extend through inner tunnel 2159 a but couplingtip 2163 a due to its larger size may be configured to extend throughouter tunnel 2159 b without passing through inner tunnel 2159 a. Inother embodiments, there may be a single tunnel that tapers (similar totunnel 1759 c in FIG. 17c ) from a larger dimension on the outer side ofbead 2151 to a smaller dimension toward the inside of the bead relativeto the lysing tip 2110.

In some embodiments, at least a portion of grasping plate 2161 maycomprise a conductive material and may be configured to receiveelectrosurgical energy, such as from a grasping/control instrument 2190or another surgical tool or external wire, and deliver such energy tolysing member 2160. For example, in some such embodiments,electrosurgical energy may be delivered through grasping jaws 2193a/2193 b, into grasping plate 2161 and into lysing member 2160. In otherembodiments, grasping plate 2161 may be insulated and electrosurgicalenergy may instead be delivered to lysing tip 2110 in another manner.For example, upper jaw 2193 a may be insulated but comprise one or morenon-insulated projections 2196 a and 2196 b that may correspond to oneor more non-insulated openings 2173 a and 2173 b respectively ingrasping plate 2161 (that is otherwise substantially insulated).Although a single projection/opening may be used in some embodiments, itmay be preferable to have two such projections/openings as depicted inFIGS. 21b and 21c . Providing two or more projections/openings mayimprove stability of the lysing tip during treatment. One or both of theprojections/openings may be configured to deliver electrosurgical energyfrom instrument 2190 to lysing tip 2110. This configuration withmultiple projection/opening pairs may be used in similar embodimentsdisclosed herein.

In embodiments comprising a free-floating lysing tip, including theembodiments of FIGS. 17-31 and 35-38, certain preferred embodiments mayhave a size/length TL (as illustrated in FIGS. 8d /8 e) of about 15 mmfrom the end of one protrusion and/or bead to the oppositeprotrusion/bead on the opposite end; the height BH (as illustrated inFIGS. 8d /8 e) of the largest outer beads may range from 2 mm to 10 mm.In some embodiments, this dimension may be defined by the distance fromthe upper end of one or more (in some embodiments, each) beads to thelower end of one or more beads. In some free-floating embodiments, thelysing tip may have a size/width TW (as illustrated in FIGS. 8d /8 e) ofabout 4.5 mm from the distal end of the beads to the proximal end of thelysing tip. However, it should be understood that a wide variety ofalternative shapes and/or sizes may be usable depending upon theparticular surgical procedure involved.

FIGS. 22a-e illustrate system 2200 comprises lysing tip 2210 andgrasping/delivery instrument 2290, this embodiment only differing fromsystem 2100 in that beads 2251 a/2251 b are rounded on the outerproximal corners 2253 a/2253 b relative to the axis of thegrasping/control instrument 2290. Rounding the outer proximal cornersmay further inhibit lysing tip 2210 from catching tissue rather thancutting or bluntly separating said tissue. Lysing tip 2210 comprisesgrasping plate 2261, lysing rod 2260, and 2 beads 2251 a/2251 b throughwhich lysing rod 2260 extends (through tunnels in beads 2251 similar totunnels through beads 2151 a/2151 b in FIG. 21a-21e ). Each of beads2251 may be coupled to lysing rod 2260 by coupling tips 2263 a/2263 band as otherwise set forth herein. Upper and lower jaws 2293 a/2293 b(that, when closed, define receiving slot 2297) respectively may graspgrasping plate 2261. Lysing tip 2210 is configured to be completelyseparable from the grasping/control instrument 2290 of the system.Lysing tip 2210 may comprise a plurality of protrusions 2201 comprisingbeads 2251 a/2251 b and recessions 2202 between the bead pairs.

FIGS. 23a-d illustrate system 2300 comprising lysing tip 2310 andgrasping/control instrument 2390, this embodiment only differing fromsystems 2100 and 2200 in that beads 2351 have an ellipsoidal shape alongthe entire length of the beads and comprise holes 2355 which may beconfigured for receipt of a cord that may be a suture, hook, or similardevice that may grasp and hold lysing tip 2301. This may be used as asafety feature for ensuring that a surgeon has the ability to retrievelysing tip 2301 in the event that it becomes uncoupled from instrument2390. This additional length as compared to the shapes of the beads inembodiments in FIGS. 21a-e and 22a-e may assist in maintaining theoptimal positioning for beads 2351 to migrate through and/or separateand/or cut tissue. Lysing tip 2310 comprises grasping plate 2361, lysingrod 2360, and 2 beads 2351 through which lysing rod 2360 extends(through tunnels in beads 2351 similar to tunnels through beads 2151a/2151 b in FIG. 21a-21e ). Each of beads 2351 may be coupled to lysingrod 2360 by coupling tips 2363 and as otherwise set forth herein. Upperand lower jaws 2393 a/2393 b respectively may grasp grasping plate 2361.Lysing tip 2310 is configured to be completely separable from thegrasping/control instrument 2390 of the system. Lysing tip 2310 maycomprise a plurality of protrusions 2301 comprising beads 2351 andrecessions 2302 between the bead pair.

Given the extra length of the beads 2351 in this embodiment, material isavailable for holes 2355. Hole(s) 2355 may, together with a cord 2344,for example, comprise an example of means for detachably maintainingretrievability of a lysing tip. In preferred embodiments and/orimplementations, suture 2344 or another loopable element may be loopedthrough one or more such hole(s) and then may extend through one or morecannulas used to deliver lysing tip 2310 proximally back to a surgeon.In this manner, in the event of a failure to grasp or otherwise couplelysing tip 2310 to a grasping/control instrument, such asgrasping/control instrument 2390, lysing tip 2310 may be retrieved fromwithin a patient's body by pulling on suture 2344 to retract lysing tip2310 though a cannula. In some embodiments, hole 2355 may also oralternatively be used to maintain position of lysing tip 2310 whileawaiting delivery of a grasping/control instrument 2390 for performingsurgical procedures. Upon properly coupling lysing tip 2310 with anappropriate tool for grasping and/or controlling lysing tip 2310, suchas grasping/control instrument 2390, a surgeon may cut suture 2344,preferably near a knot or other feature used to form a loop around hole2355. If a suture 2344 or other similar material/element is used that issufficiently flexible and non-disruptive, this shorter loop may beconfigured to be present during a surgical procedure using lysing tip2310 without unduly interfering with the procedure. In alternativeembodiments, holes 2355 may be available as a platform/location to addother features/components such as providing a location for a placementof one or more sensors and/or RFID location component(s) and/or beingused for placement of luminescent and/or light production element(s) forvisualization, for example, tritium and the like.

In alternative embodiments, hole 2355 may be moved to fully or partiallyintersect tunnel 2354 thus allowing communication with lysing rod 2360;thus a weld, plug, glue, insert or other method of fixation may beinserted via hole 2355 to attach to lysing rod 2360 thus restrictinglateral movement of a bead. To reduce escape of electrosurgical energythrough hole 2355, an insulator comprised of epoxy, plastic, ceramic orthe like may be placed in part or all of the remaining hole 2355. Thisalternative embodiment may be applied to other embodiments herein.

Another embodiment is depicted in FIGS. 24a and 24b . System 2400comprises modular lysing tip 2410 comprising recessions 2402 created byadjacent protrusions 2401. Lysing tip 2410 further comprises a supportmember 2470 defining a bow shape 2470 that may be coupled physically andelectrically to a shaft 2499 a extending proximally from bow 2470. Shaft2499 a may be conductive and/or may reversibly couple with conductiveslot 2479 s formed in an electrosurgical instrument 2479 which may be anelectrosurgical pencil (such as a ‘Bovie’ and/or other electrosurgicalpencil and/or other electrosurgical adaptive device(s)) capable ofreceiving shaft 2499 a, through which electrosurgical energy may bedirected and controlled to lysing tip 2410. Lead 2479L may be coupledwith an electrosurgical generator. Beads 2451 a/2451 b/2451 c/2451 d maycomprise facets 2452 and may be coupled to support member 2470 by lysingrod (not shown in FIGS. 24a /24 b) which is covered by spacers 2462a/2462 b/2462 c. Coupling tips 2463, as stated earlier herein, couplethe lysing rod in place within outer beads 2451 a/2451 d. Insulation2499 b may cover or substantially cover shaft 2499 a to facilitatehandling by personnel and may be extended to cover all or portions ofbow 2470 preventing electrosurgical energy from being distributed totissue from the bow 2470. This embodiment may have uses in opensurgeries and/or non-CDTD procedures.

An alternative embodiment is depicted in FIG. 24c . System 2400′comprises modular lysing tip 2410′ (which is comprised of outer beads2451 a′/2451 d′, and lysing rod 2460′), shaft 2499 a′ and insulatedcovering 2499 b′ that terminates distally with bulbousprojection/protrusion 2499 t. One or more of the exposed segments oflysing rod 2460′ may be covered by spacers 2462′. Lysing rod 2460′ maybe electrically coupled to a shaft 2499 a′ extending proximally fromlysing rod 2460′. Shaft 2499 a′ may be conductive and/or may reversiblycouple with an electrosurgical instrument 2479 which may be anelectrosurgical pencil (such as a ‘Bovie’ and/or other electrosurgicalpencil and/or other electrosurgical adaptive device(s)) capable ofreceiving shaft 2499 a′ within a conductive slot 2479 s through whichelectrosurgical energy may be directed and controlled to lysing tip2410′. Insulated covering 2499 b′ may cover or substantially cover shaft2499 a′ to facilitate handling by personnel and may be extended distallyin the shape of or to substantially mimic the shape of the distalportion of a bead 2451 a′/2451 d′, thus serving as a 3^(rd)projection/bead. More particularly, this bulbous protrusion 2499 t mayextend distally as far as the tips of beads 2451 a′/2451 d′. Thisembodiment may have uses in open surgeries and/or non-CDTD procedures.

The CDTD and/or non-CDTD systems and/or apparatus (hereafter “TD”)disclosed herein may be used to treat the following disclosed below.

In a general implementation of a method using one or more of the devicesdescribed herein, a tip deployment pocket may be created at or near theentrance incision, for example, in skin or muscle. Alternatively, someimplementations may not require a tip deployment pocket. The lysing tipof the TD may be inserted through the entrance incision and in someimplementations into the tip deployment pocket while in otherimplementations directly into a body cavity. The lysing tip may then bereconfigured from a delivery configuration to a treatment configurationsuch as by rotating the lysing tip and/or coupling the lysing tip to agrasping/control instrument. The lysing tip may then be activated. Adissection path may then be made to one or more target tissues. Thelysing tip may then be used to dissect around or through target tissuesand/or used to treat the target tissue. In some implementations, the oneor more target tissues and/or surrounding tissues may then be treated toachieve hemostasis with the lysing tip or the tissue modification tip(TMT). The lysing tip may then be rotated back to a deliveryconfiguration to allow the lysing tip to be withdrawn. In someimplementations, the lysing tip may delivered and/or withdrawn using oneor more cannulas. In other implementations, the lysing tip may deliveredand/or withdrawn without a cannula.

In FIGS. 25a-e , system 2500 a tether 2544 extends through an opening2593 h formed in a jaw 2593 of the grasping/control instrument 2591.Tether 2544 may further be configured to be coupled with free-floatinglysing tip 2510 that may be comprised of support member/bow 2570,grasping pad 2571 located on support member/bow 2570, beads 2551,spacers 2561, and rod (not shown). In the depicted embodiment, tether2544 couples with grasping pad 2571. More particularly, grasping pad2571 comprises an opening 2571 h configured to receive the tether 2544as shown in the cross-sectional view of FIG. 25d . In some embodiments,the opening 2571 h may comprise a blind opening in which case tether2544 may comprise a distal bulb 2544 c and/or stop that prevents tether2544 from pulling through the opening 2571 h. Alternatively, opening2571 h may comprise a through-hole which may allow tether 2544 to extendall the way through opening 2571 h on both ends of the opening.

In the depicted embodiment, by pulling on tether 2544 either manually orby way of a mechanism, tip 2510 may be configured to be directed intothe jaws 2593/2594 of grasping/control instrument 2591. In still otherembodiments, tether 2544 may be coupled with tip 2510 without alsoextending through one or both of jaws 2593/2594. In this manner the tip2510 may be retrieved simply by pulling on the tether 2514. In otherembodiments, a tether 2544 may extend through other portions of thegrasping instrument, such as the bottom jaw 2594 and/or both jaws2593/2594 and/or through the center of the grasping/control instrument5191.

In some embodiments, one or more magnets may be used to guide lysing tip2510 towards and/or lock lysing tip 2510 in a desired location such aswithin jaws 2593/2594 of the grasping control instrument 2591. Forexample, one or more magnets may be positioned along grasping pad 2571(magnet 2592 p) and/or within one or both of jaws 2593/2594 (magnet 2592j) of system 2500. If a magnet is positioned within one or both jaws2593/2594, grasping pad 2571 may comprise a magnetic portion and/orelement configured to engage such magnet(s). Similarly, if a magnet ispositioned on grasping pad 2571, a magnetic portion and/or element maybe positioned within one or both jaws. Alternatively, magnets may bepositioned on both the grasping pad and one or both of the jaws.

The tether may be packaged with a tether already attached or medicalpersonnel at the procedure may choose an appropriate tether to threadand catch in the lysing tip and thread through the jaw with thethrough-hole.

The surgeon may attach the cord/suture to hole 2571 leaving a tail ofstitch that may be up to 50 cm long. The grasping instrument 2591containing hole 2593 h may be inserted into the body percutaneously andexit through an larger trocar for example located in the umbilicus. Thetail of the suture/cord may then be pulled back out the originalpercutaneous incision and fed through hole 2593 h. The graspinginstrument containing hole 2593 h may then be reinserted percutaneouslyand the lysing tip 2510 fed down the second (for example, umbilicaltrocar) percutaneous body cavity entry/wound. The cord/suture tail isthen pulled by the surgeon to seat the frame within the grasper.

Yet another embodiment of a lysing tip 2610 comprising beads 2651 a/2651b/2651 c/2651 d is depicted in FIGS. 26a and 26b . Lysing tip 2610comprises a support member 2670 which may be in the approximate shape ofa bow as previously discussed. However, the distal end of lysing tip2610 is bowed in the opposite direction such that middle beads 2651b/2651 c protrude distally to a greater degree than outer beads 2651a/2651 d. In addition, lysing rod 2660 rather than being straight as inprevious embodiments collectively curves and/or bows distally. In someembodiments, however, each of the various segments 2662 a/2662 b/2662 cbetween adjacent beads may be straight or be substantially straight. Asalso previously discussed, support member 2670 may comprise an opening2673 which may be configured to receive a tooth or other projection of agrasping/control instrument (not shown in this figure, but depicted inother embodiments). In FIG. 26a , support member 2670 may furthercomprise a tongue 2676 that protrudes distally to couple with the centersegment of lysing rod 2660. More particularly, in the depictedembodiment, tongue 2676 comprises a groove defined on either side byedges 2676′ configured to receive center segment of lysing rod 2660 soas to deliver electrosurgical energy from an instrument into lysing rod2660. As previously discussed, each of the various segments of lysingrod 2660 is preferably electrically coupled through adjacent beads toits adjacent lysing member. As shown in FIG. 26a , spacers may beprovided between outer beads and but not the adjacent middle beads. Thismay be because tongue 2676 a/2676 a′ may serve as a suitable spacer.However, as shown in FIG. 26b , in some embodiments, center spacer 2662b may be provided on the center segment of lysing rod 2660 if needed ordesired.

FIGS. 27-30 comprise various embodiments of free-floating lysing tipsthat may be used with the various surgical tools set forth, for example,in FIGS. 17a-m . However, alternative embodiments are contemplated inwhich these free-floating lysing tips may instead be modified so as tobe coupleable with actuation rods and/or one or more cannulas as setforth herein such that the free-floating lysing tips becomenon-free-floating lysing tips as shown, for example, in FIGS. 14a -n.

In FIGS. 27a-j , lysing tip 2710 is “free-floating” (can be uncoupledfrom any control instrument or cannula) and comprises a plurality ofsleeves 2780/2781 positioned on lysing rod 2760 which may correspond innumber to the number of beads 2751 a/b/c/d. Beads 2751 a/b/c/d may bemolded onto or otherwise positioned onto one or more sleeveconfigurations, for example, outer bead sleeve configuration 2780 a/2780b and middle bead sleeve configuration 2781 a/2781 b. Preferably sleeves2780/2781 are made of a material configured to insulate the materialmaking up the beads from the heat generated by the lysing rod 2760during a surgical procedure. Sleeves 2780/2781 may also or alternativelyserve as hubs permitting rotation of beads around the axis of lysing rod2760. For example, the beads may rotate about the rod upon encounteringtissue similar to that of a vegetable/fruit peeler.

Middle bead sleeve 2781 may comprise a raised band 2784 which is formedat a central or substantially central location around both middle-beadsleeves 2781 a/2781 b which may serve to prevent lateral movement ofmiddle beads 2751 b and/or 2751 c off of middle-bead sleeves 2781 a/2781b. Bead band channel 2753 may be configured to accept raised band 2784.Likewise, outer bead sleeves 2780 a/2780 b comprise an external ledge2786 a and internal ledge 2786 b that transitions between a largerdiameter portion 2782 and a smaller diameter portion 2783 of an innertunnel of the outer bead sleeves. The larger diameter portion 2782 isalternatively referred to herein as a raised band. In some preferredembodiments comprising bead sleeves, the beads may comprise a molded ormoldable material, such as a moldable, biocompatible plastic, gelatin(for example, protein, polysaccharides and/or derivatives thereof), orhydrogel, for example. In some such embodiments, the beads may beovermolded onto each of their respective sleeves.

External sleeve ledge 2786 a may be configured to engage a correspondinginternal bead ledge 2759 within outer beads 2750 a/2750 b. Similarly,outer bead sleeves 2780 a/2780 b may comprise two concentric holes withledge 2786 b approximately half-way between the opposite openings.Internal bead ledge 2786 b may be configured to engage coupling tips2763. This configuration creates a feature that may prevent lateralmovement of outer beads 2751 a/2751 d off of outer bead sleeves 2781a/2781 b. In other embodiments, coupling tip 2763 may engage a singletunnel that tapers (similar to tunnel 1759 c in FIG. 17c ) from a largerdimension on the outer side of bead to a smaller dimension toward theinside of the bead as depicted in FIG. 27j . In some embodiments, it maybe desirable to provide features and/or elements that inhibit or limitthe ability of the electrosurgical energy to discharge from the opposingends of the lysing rod 2760 at coupling tips 2763. Thus, in some suchembodiments, coupling tips 2763 may be coated or covered with a suitableinsulating material such as an epoxy with non-conductive properties.Alternatively, outer bead hole 2754 at the end with the larger-openingmay be capped or plugged with an element configured to be received orotherwise engage the larger opening of the bead. Preferably, thiselement will have non-conductive properties similar to the insulatingmaterial previously referenced.

As depicted in FIG. 27c , lysing tip 2710 may comprise protuberances2765 c/2765 d positioned on/coupled to lysing rod 2760, one protuberance2765 c/d may be positioned on each side of each middle bead 2751 c asshown in FIG. 27c . Protuberances 2765 c/d may serve to prevent or limitlateral movement of middle beads 2751 b/2751 c on the lysing rod 2760and/or may, depending upon a protuberance pair's distance from a bead,serve to limit or prevent rotation of beads around the axis of lysingrod 2760. In alternative embodiments, one or more spacers 2762 (and suchas those in FIGS. 9a-9e , spacers 962) may be used in place ofprotuberances 2765 c/d. In the depicted embodiment, spacer 2762 in FIG.27c is pentagonal in cross-section; in other embodiments, alternativespacers with unique cross-sectional configurations, such as for examplethose set forth in FIGS. 12h-t , may be used. In alternativeembodiments, lysing rod 2760 may be deformed prior to coupling with amiddle bead sleeve such that the outer diameter of 2760 may couple viafriction fit with the inner tunnel surface of middle bead sleeve 2781.FIGS. 27b and 27c purposefully have components removed to expose innercomponents and also illustrate different means to hold middle beads inan intended position via protuberances and/or spacers. Alternatively,middle bead sleeves 2781 may be more loosely coupled with lysing rod2760 so as to allow for rotation of middle bead sleeve 2781 thereon, andthereby allow for at least some rotation of their corresponding beads onlysing rod 2760. In alternative embodiments, lysing tip 2710 may beconfigured without a solid lysing rod and/or without spacers and/orwelds and the like. In such embodiments, internal bead tunnels 2754 andsupport member holes 2767 a/2767 b may be configured to accommodate ahollow lysing rod similar to that depicted in FIG. 17k . Between beads,the hollow lysing rod may be deformed in a manner to prevent lateralmovement of beads and/or prevent rotation of beads. The hollow lysingrod may be deformed minimally or to a point that it is substantiallyflat. In such embodiments, it may be preferable for the front edge topoint distally as the leading front edge. In such embodiments, screwsmay secure one or both ends of the hollow lysing rod within outer beads2751 a/2751 d. The configurations of this alternative embodiment may beavailable for any other similar embodiment contemplated herein.

In this configuration, adjacent protrusions 2701 create recessions 2702in which recessed lysing rod 2760 may deliver electrosurgical energyduring a surgical procedure.

FIG. 27e illustrates a perspective view of outer bead 2751 a/2751 dcoupled to outer bead sleeve 2780 with coupling tip 2763 being recessedwithin outer bead sleeve 2780 a. Lysing rod 2760 is illustrated in FIG.27d being received within outer bead sleeve 2780. FIG. 27d illustrateshow lysing rod, sleeve and bead may be assembled: Outer bead sleeve 2780a may be extended into outer bead 2751 a stopping at the point thatexternal sleeve ledge 2786 a reaches the internal bead ledge 2759 whichmay be followed by extension of lysing rod 2760 through outer beadsleeve 2780 a stopping at the point coupling tip 2763 reaches theinternal sleeve ledge 2786 b created by the larger-diameter middle beadsleeve hole 2787 b and smaller-diameter sleeve hole 2787 a. Inalternative embodiments, as depicted in FIG. 27j , the sleeve 2780′ maybe configured to have a single cone-shaped tunnel 2786′ that tapers(similar to tunnel 1759 c in FIG. 17c ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the beadin order to engage coupling tip 2763.

Outer beads 2751 a/d may comprise hole 2755 through which a cord may behooked and/or tied in order to facilitate deployment or retrieval asearlier stated herein regarding hole 1755 in FIG. 17 d.

Support member 2770 may be preferably insulated, except for regions onwhich it is desired to transfer electrosurgical energy such as (1) atone or more surfaces of grasping pad 2771, (2) within the 2 distalsupport member holes (as shown in FIG. 12e, 1267a /1267 b), and/or (3)the opposing distal ends of support member 2770, in some cases distal oflysing rod 2760 in order to deliver electrosurgical energy not onlythrough lysing rod 2760 but also through these distal ends of supportmember 2770.

Support member 2770 in the current embodiment comprises a bow shapecomprising two opposing end tips comprising holes or other openingsthrough which lysing rod 2760 extends. The two tips of support member2770 may extend far enough distally to provide sufficient material toform the lysing rod through-holes. Alternatively, openings comprisingslots or the like may be formed at one or both of the two opposing tipsof support member 2770 if desired.

The two tips of support member 2770 preferably do not extend beyond thedistal tip of any bead and preferably remain as proximal to lysing rod2760 as possible. The ends/tips of support member 2770 may or may not beelectrically insulated. If insulated, said tips will act more like beads2751 a/b/c/d to physically separate tissues or tissue planes; however,if not insulated, said tips may perform like lysing rod 2760 deliveringelectrosurgical energy to lyse tissue.

FIGS. 27h-i illustrates middle bead 2751 b comprised of facets 2752 (2of a total of 4 on this bead are identified in the illustration),coupled to middle bead sleeve 2781 through which lysing rod 2760extends. Middle bead 2751 b may differ from outer bead in that itslength may be shorter and its rear wall 2758 may be flat orsubstantially flat. The length of middle bead 2751 b may be such thatthe rear portion of middle bead 2751 b/c may not contact support member2770 in its relaxed state and/or when the bead's distal tip is pointingin the same direction as lysing tip 2710, however, middle bead 2751 bmay contact support member 2770 if lysing rod 2760 is pushed back orotherwise deformed during a surgical procedure and/or the middle bead2751 b/c is rotated about the lysing rod 2760 such that the top orbottom of the rear portion of the bead may contact support member 2770.For example, the spacing between middle beads 2751 b/c and supportmember 2770 may be used to selectively limit the amount with whichmiddle beads 2751 b/c may rotate. Similarly, in some embodiments, thisspacing may be configured to serve as a backstop to allow for apredetermined amount of proximal movement of middle beads 2751 b/cduring a procedure.

In FIGS. 28a -L, outer beads 2851 a/2851 d define an annular shape. toMore particularly, outer beads 2851 a/2851 d comprise annular beadstructure 2857. In addition, these beads may be elongated or oval incross section. Middle beads 2851 b/2851 c on the other hand have similardefined protrusions on their distal ends, however, proximal ends ofthese beads terminate in opposing knobs 2855 rather than defining a fullannular shape. In both middle and outer beads, a bead hub 2856 ispositioned within annular bead structure 2857 to allow for coupling ofbeads 2851 with their corresponding sleeves. Bead hub 2856 is coupled toannular bead structure 2857 by way of one or more spokes 2858 and/or abead hub frame 2856 a. In the depicted embodiment, bead hub frame 2856 aextends about a central portion of bead hub 2856 from bead hub 2856 toannular bead structure 2857. Bead hub frame 2856 a is only coupled to aportion of annular bead structure, and a portion of bead hub 2856.However, alternative configurations are possible in which bead hub frame2856 a may be coupled to the entire annular bead structure 2857 and/orthe full periphery of bead hub frame 2856 a. A single spoke 2858 mayextends from bead hub 2856 in a direction perpendicular to bead hubframe 2856 a. As best depicted in FIG. 28k , spoke 2858 protrudeslaterally (towards opposite lateral ends of the lysing tip) in bothdirections beyond a profile of the annular bead structure 2857. However,bead hub frame 2856 a does not protrude laterally in this manner. Spoke2858 also extends from bead hub frame 2856 a. However, other embodimentsare contemplated in which additional spokes may be used, in some suchembodiments in place of a bead hub frame 2856 a, as discussed below.Such annular shapes may be beneficial components may be less costly toproduce, they may withstand heat generated from the interaction ofelectrosurgical energy with tissue, and they may provide more benefitsfor dissecting the more delicate tissues such as those found in theabdomen including tissues attached to bowel and mesentery.

In this configuration, adjacent protrusions 2801 create recessions 2802in which recessed lysing rod 2860 may deliver electrosurgical energyduring a surgical procedure.

FIG. 28d is a side view of lysing tip 2810 comprising support member2870, coupling tip 2863, spokes 2858 a/2858 b/2858 c coupling bead hub2856 with bead annular structure 2857.

FIGS. 28e and 28f illustrate perspective and side views of outer beads2851 coupled to outer bead sleeve 2880 through which lysing rod 2860extends. Bead hub 2856 may be formed on outer bead sleeve 2880, said hubcoupling to inner surface of annular structure 2857 via spokes 2858a/2858 b/2858 c.

Outer bead sleeves 2880 a/2880 b may comprise an internal and/or anexternal ledge that transition between a larger diameter portion and asmaller diameter portion of the outer bead sleeves. For example, outerbead sleeve may comprise an external sleeve ledge 2886 a and internalsleeve ledge (as illustrated in FIGS. 27a-j , internal sleeve ledge 2786b). External sleeve ledge 2886 a may be configured to engage acorresponding internal bead ledge (as illustrated in FIGS. 27a-j ,internal bead ledge 2759). within outer beads 2850 a/2850 b. Moreparticularly, outer bead sleeves 2880 a/2880 b may comprise twoconcentric holes with an internal bead ledge approximately half-waybetween the opposite openings. The internal bead ledge may be configuredto engage coupling tips 2863. This configuration creates a feature thatmay prevent lateral movement of outer beads 2851 a/2851 d off of outerbead sleeves 2881 a/2881 b.

FIG. 28h illustrates how lysing rod, sleeve and bead may be assembled:Outer bead sleeve 2880 a may be extended into outer bead 2851 a stoppingat the point that external sleeve ledge 2886 a reaches the internal beadledge which may be followed by extension of lysing rod 2860 throughouter bead sleeve 2880 a stopping at the point coupling tip 2863 reachesthe internal sleeve ledge created by the larger-diameter inner sleevehole and smaller-diameter sleeve hole (as illustrated in FIGS. 27a-j atinternal sleeve hole 2186 a and external sleeve hole 2186 b).

As depicted in FIGS. 28a -L, lysing rod 2860 may be deformed prior tocoupling with bead sleeves in the areas to be coupled with the sleevessuch that the outer diameter of lysing rod 2860 may couple via frictionfit with the inner tunnel surface of middle bead sleeve 2881. Forexample, these regions may be flattened slightly or otherwise made intoa slightly elongated or oval shape so as to improve the ability of thesleeves to engage the lysing rod in these regions via friction fit. Inalternative embodiments, lysing tip 2810 may comprise protuberancespositioned on/coupled to lysing rod 2860, one protuberance, for example,may be positioned on each side of each middle bead 2851 c. Protuberancesmay serve to prevent or limit lateral movement of middle beads 2851b/2851 c on the lysing rod 2860 and/or may, depending upon aprotuberance pair's distance from a bead, serve to limit or preventrotation of beads around the axis of lysing rod 2860. In alternativeembodiments, one or more spacers (and such as those in FIGS. 10a-h ,spacers 1062) may be used in place of protuberances 2865. Alternatively,middle bead sleeves 2881 may be more loosely coupled with lysing rod2860 so as to allow for rotation of middle bead sleeve 2881 thereon, andthereby allow for at least some rotation of their corresponding beads onlysing rod 2860.

In alternative embodiments, the sleeve may be configured to have asingle cone-shaped tunnel that tapers and may engage coupling tip(similar to tunnel 2186′ in FIG. 28j ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the bead.In alternative embodiments, lysing tip 2810 may be configured without asolid lysing rod and/or without spacers and/or welds and the likesimilar to that depicted in FIG. 17k . Between beads, the hollow lysingrod may be deformed in a manner to prevent lateral movement of beadsand/or prevent rotation of beads. The hollow lysing rod may be deformedminimally or to a point that it is substantially flat. In suchembodiments, it may be preferable for the front edge to point distallyas the leading front edge. In such embodiments, screws may secure one orboth ends of the hollow lysing rod within outer beads 2851 a/2851 d. Theconfigurations of this alternative embodiment may be available for anyother similar embodiment contemplated herein.

FIGS. 28i -L illustrate middle bead 2851 b/2851 c coupled to middle beadsleeve 2881 through which lysing rod 2860 extends and from which middleband 2984 protrudes. Middle bead 2851 b may differ from outer bead 2851a in that its length is truncated proximal to bead hub 2856 terminatingin knobs 2855. Knobs 2855 may inhibit the lysing tip 2810 from catchingtissue rather than cutting or separating it and/or may limit rotation ofmiddle bead 2851 around lysing rod 2860. The length of middle bead 2851b may be such that knobs 2855 and proximal portions of bead hub 2856 maynot contact support member 2870 in its relaxed state and/or when thebead's proximal tip is pointing in the same direction as lysing tip2810. However, in this embodiment, middle bead knobs 2855 may contactsupport member 2870 if lysing rod 2860 is deformed during a surgicalprocedure and the middle bead 2851 is rotated about the lysing rod 2860such that the top or bottom of the rear portion of the bead may contactsupport member 2870. The spacing between middle beads 2851 and supportmember 2870 may be used to selectively limit the amount with whichmiddle beads 2851 may rotate. In this embodiment, support member 2870may not serve as a backstop to permit a predetermined amount of proximalmovement of middle beads 2851 a/2851 b during a procedure. Middle beadsleeve may comprise raised band 2884 to engage the bead to limit lateralmovement.

FIGS. 29a-f differs from that of 28 a-L in that middle beads 2951 b/2951c instead of terminating at knobs (knobs 2855 in FIGS. 28a -L) define anannular shape having a flattened or slightly arced rear end 2955 andouter beads comprise less bead hub frame material by directly attachingthe proximal portion of the distal tip to the bead hub 2256.

Adjacent protrusions 2901 create recessions 2902 in which recessedlysing rod 2960 may deliver electrosurgical energy during a surgicalprocedure.

FIG. 29c is a side view of lysing tip 2910 comprising support member2970, coupling tip 2963, spoke 2958 a with direct connection points 2958g/2958 h coupling bead hub 2956 with outer bead 2951 a/2951 d annularstructure 2957.

In both middle and outer beads, a bead hub 2956 couples with itscorresponding sleeve. In middle beads, one or more spokes 2958 a/2958b/2958 c may extend from bead hub 2956 to the annular structure 2957 assupport and bead hub frame 2956 a by itself or in conjunction withspokes may couple the annular structure to bead hub 2956. As illustratedin FIG. 29c , outer beads 2951 comprise bead hub 2956 coupled to annularstructure 2957 by spoke 2958 a at the distal portion of the bead anddirect coupling of bead hub 2956 to the material comprising internalportion of annular structure 2957 at direct connection points 2958 g and2958 h.

FIGS. 29e and 29f illustrate perspective views of outer bead 2951coupled to outer bead sleeve 2980 through which lysing rod 2960 extends.Bead hub 2956 may be formed on outer bead sleeve 2980.

Outer bead sleeves 2980 comprise a ledge 2986 that transitions between alarger diameter portion and a smaller diameter portion of the outer beadsleeves. Sleeve ledge 2986 may comprise an external sleeve ledge 2986 aand an internal sleeve ledge (as illustrated in FIGS. 27a-j , internalsleeve ledge 2186 b). External sleeve ledge 2986 a may be configured toengage a corresponding internal bead ledge (as may be illustrated inFIGS. 27 a-j, internal bead ledge 2159). within outer beads 2950 a/2950b. Similarly, outer bead sleeves 2980 may comprise two concentric holeswith internal bead ledge approximately half-way between the oppositeopenings. Internal bead ledge may be configured to engage coupling tips2963. This configuration creates a feature that may prevent lateralmovement of outer beads 2951 a/2951 d off of outer bead sleeves 2980.

In alternative embodiments, the sleeve may be configured to have asingle cone-shaped tunnel that tapers and may engage coupling tip(similar to tunnel 2186′ in FIG. 28j ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the bead.

As depicted in FIGS. 29a-f , lysing rod 2960 may be deformed prior tocoupling with a middle bead sleeve such that the outer diameter oflysing rod 2960 may couple via friction fit with the inner tunnelsurface of middle bead sleeve 2981. In alternative embodiments, lysingtip 2910 may comprise protuberances positioned on/coupled to lysing rod2960, one protuberance, for example, may be positioned on each side ofeach middle bead 2951 c. Protuberances may serve to prevent or limitlateral movement of middle beads 2951 b/2951 c on the lysing rod 2960and/or may, depending upon a protuberance pair's distance from a bead,serve to limit or prevent rotation of beads around the axis of lysingrod 2960. In alternative embodiments, one or more spacers (and such asthose in FIGS. 9a-9e , spacers 962) may be used in place ofprotuberances 2965 which may be positioned at any angle on the crosssection of the lysing rod, in this depiction facing proximally 2965 c/dand distally 2965 a/b. Alternatively, middle bead sleeves 2981 may bemore loosely coupled with lysing rod 2960 so as to allow for rotation ofmiddle bead sleeve 2981 thereon, and thereby allow for at least somerotation of their corresponding beads on lysing rod 2960. In alternativeembodiments, lysing tip 2910 may be configured without a solid lysingrod and/or without spacers and/or welds and the like similar to thatdepicted in FIG. 17k . Between beads, the hollow lysing rod may bedeformed in a manner to prevent lateral movement of beads and/or preventrotation of beads. The hollow lysing rod may be deformed minimally or toa point that it is substantially flat. In such embodiments, it may bepreferable for the front edge to point distally as the leading frontedge. In such embodiments, screws may secure one or both ends of thehollow lysing rod within outer beads 2951 a/2951 d. The configurationsof this alternative embodiment may be available for any other similarembodiment contemplated herein.

FIG. 29f illustrates how lysing rod, sleeve and bead may be assembled:Outer bead sleeve 2980 may be extended into outer bead 2951 a stoppingat the point that external sleeve ledge 2986 a reaches the internal beadledge which may be followed by extension of lysing rod 2960 throughouter bead sleeve 2980 stopping at the point coupling tip 2963 reachesthe internal sleeve ledge 2986 b created by the larger-diameter innersleeve hole and smaller-diameter sleeve hole (as illustrated at internalsleeve hole 2787 a and external sleeve hole 2787 b in FIGS. 27a-j ).

In FIGS. 30a-k , the beads again define an annular shape, however, thesebeads may be configured to be wider, unlike beads previously discussedwhich define in cross section an oval or circular shape, thus the beadsin this embodiment may define a more cross-sectionally elongated shapeand may be configured to have opposing upper and lower surfaces definingthe annular structure that are parallel or at least substantiallyparallel in cross-section. These beads may be referred to as annularbands and may be flexible by way of material or a combination ofmaterial and/or thicknesses and/or configuration such that they can becompressed in some embodiments either from the top and bottom or fromthe opposing distal ends. In some embodiments, beads may be resilientlyflexible such that they naturally return to their original state afterbeing compressed. Various embodiments may enable greatercompressibility, for example, by removing and/or angling a bead spokebetween the bead hub and the annular structures 3057 of beads 3051a/b/c/d.

This ability to compress and be restored may be useful to allow thelysing tip 3010 to self-adjust during certain surgical procedures, inparticular those involving the intermixing of delicate tissues withdense/fibrous tissues (such as pre-existing scar), for example, in theabdomen attached to the bowel and/or mesentery. To illustrate with moreparticularity, upon being compressed from the top or bottom, the distaltip may be deformed to form a more acute angle of attack facilitatingtissue separation and the cross sectional profile along the height ofthe tip may be reduced. Similarly upon encountering more dense and/ormore fibrous tissue at the distal tip, the tip may slow or ceasemovement, however, the force from the surgeon's motion will continue topush the lysing segment closer to the more dense and/or more fibroustarget tissue effectively providing more enhanced power to lyse thetissue rather than requiring an increase of the power from theelectrosurgical generator. In some embodiments, this may also reduce theneed for increasing power from the electrosurgical generator in order tolyse and/or separate such tissues. This may also enhance safety becauseit may be safer for patient safety to operate electrosurgical generatorsat the minimum necessary power. FIGS. 30a and 30b illustrate perspectiveand upper views respectively of protrusions 3001, recessions 3002, beads3051 a/3051 b/3051 c/3051 d, lysing rod 3060, and support member 3071partially comprising grasping pad 3071. FIG. 30c is a side view oflysing tip 3010 illustrating the side and middle beads 3051 a/b/c/d andsupport member 3070. FIG. 30d illustrates a middle bead 3051 b or 3051 cwith bead hub 3056 and spokes 3058 a/3058 b; other than the shape of thebead, its structure in coupling to the lysing rod 3060 (middle and outersleeves 3080 and 3081 respectively) is similar to outer beads 3051a/2451 b and similar to the embodiments in FIGS. 27-29 via coupling tip3063. FIGS. 30e-30k illustrate perspective, side elevation, and top planviews of an outer bead in relaxed and compressed states. FIGS. 30e /30h/30 j illustrate bead 3051 a/3051 d in the relaxed and/or “asmanufactured” state from perspective, side, and upper views. FIGS. 30f/30 i/30 k illustrate the same bead 3051 a/3051 d in a compressed state,thus, it is elongated along the beads BL axis as previously described inFIGS. 8d and 8e . FIG. 30g illustrates outer bead sleeve 3080 on whichouter bead 3051 a and/or 3051 d may be coupled.

Outer beads 3051 a/3051 d and middle beads 3051 b/3051 c comprise beadhub 3056 and annular structure 3057 coupled via only 2 spokes 3058a/3058 b terminating on annular structure 3057 proximally of bead hub3056. This configuration may allow lysing rod 3060 to move closer totissue located distally to deliver more concentrated electrosurgicalenergy when the most distal portion of outer bead annular structure 3057is inhibited in its distal progress by dense/fibrous tissue. In someembodiments, spokes may comprise a different material from the bead hub.Such material may be more flexible to allow for greater movement oflysing rod 3060. Alternatively, spokes 3058 a/3058 b may comprise thesame material and the flexibility may be provided by altering thethickness of the material.

As depicted in FIGS. 30a-k , in order to prevent lateral movement ofmiddle beads, lysing rod 3060 may be deformed prior to coupling with amiddle bead sleeve such that the outer diameter of lysing rod 3060 maycouple via friction fit with the inner tunnel surface of middle beadsleeve 3081. In alternative embodiments, lysing tip 3010 may compriseprotuberances positioned on/coupled to lysing rod 3060, oneprotuberance, for example, may be positioned on each side of each middlebead 3051 c. In some embodiments, protuberance 3065 may be positioned toface in any direction, including distally and proximally. Protuberancesmay serve to prevent or limit lateral movement of middle beads 3051b/3051 c on the lysing rod 3060 and/or may, depending upon aprotuberance pair's distance from a bead, serve to limit or preventrotation of beads around the axis of lysing rod 3060. In alternativeembodiments, one or more spacers (and such as those in FIGS. 11a-11e ,spacers 1162) may be used in place of protuberances 3065. Alternatively,middle bead sleeves 3081 may be more loosely coupled with lysing rod3060 so as to allow for rotation of middle bead sleeve 3081 thereon, andthereby allow for at least some rotation of their corresponding beads onlysing rod 3060.

In FIG. 30b , the end tip of support member 3070 may be coated with anon-conductive coating, thus, the area of relative protrusion 3001 maybe wider and may perform more blunt dissection than if the end tip werenot so coated.

In alternative embodiments, the sleeve may be configured to have asingle cone-shaped tunnel that tapers and may engage coupling tip(similar to tunnel 2786′ in FIG. 27j ) from a larger dimension on theouter side of bead to a smaller dimension toward the inside of the bead.

As depicted in FIGS. 31a-e , alternative embodiments are contemplated inwhich free-floating lysing tips may instead be modified so as to becoupleable with actuation rod pairs 3121/3123 and 3122/3124 and/or oneor more cannulas 3131 and/or 3132 as set forth herein such that thefree-floating lysing tips become non-free-floating lysing tips, as shownin FIGS. 31a-e . The figures only differ from one another as to thestyle of bead. In all configurations, bead length may be limited toensure that lysing tip may rotate sufficiently into a deliveryconfiguration that permits entry and egress of the lysing tip through anouter cannula and/or an entrance incision. FIGS. 31a and 31b depictbeads 3151 e-h which may be similar or identical to the middle beads ofFIGS. 28, namely 2851 b/2851 c. FIG. 31c depicts beads 3151 i-L whichmay be similar or identical to the middle beads of FIGS. 27a-j , namely2751 b/2751 c. FIG. 31d depicts beads 3151 m-p which may be similar oridentical to the middle beads of FIGS. 29a-f , namely 2951 b/2951 c.FIG. 31e depicts beads 3151 q-t which may be similar or identical to themiddle beads of FIGS. 30a-k , namely 3051 b/3051 c. Support member 3170is coupled to the lysing rod supporting the beads.

Any of the configurations of FIGS. 31a-e may comprise canal(s) 3104(shown in FIG. 31a only) which may be positioned to supply one or morefluids to the surgical site around or near lysing tip 3110 via a portlocated adjacent to the internal device cannula and/or lysing tip. Canal3104 may be configured to be extended and withdrawn as needed. Inalternative embodiments, other fluids that may pass down canal 3104 mayinclude, but not be limited to, cold nitrogen gas, fluorocarbons, etc.,which might cool and/or freeze tissue to alter it in a desired fashion.

FIGS. 32a /32 b/32 c illustrate a tissue modification tip (TMT) system3200 comprising center-mounted actuation rod 3221, side actuation rod3222 coupled to proximal actuation rod 3224, inner cannula 3231 andouter cannula 3232 and a TMT 3211 comprising energy window array 3213and tip cover 3212. FIG. 32b illustrates the tip in the intermediateposition between the delivery and treatment configurations. FIG. 32cillustrates the tip recessed within inner cannula 3231. In alternativeembodiments, TMT 3211 may be configured such that it may not be able torecess within inner cannula 3231. Isolated energy window(s)/termini3213′ may be any shape or configuration of shapes so long as they areelectrically isolated relative to the tissue being exposed.

In some embodiments, energy window array 3213 may comprise multipleisolated energy window termini 3213′ through which energy is dischargedto multiple locations on the exposed tissue at the same time. The tip ofeach isolated energy window termini 3213′ may extend above the topsurface of cover 3212 to attain a desired effect and/or be slightlyrecessed relative to cover 3212. The energy discharged may beelectrosurgical energy of any type or, more specifically, may be‘coagulation’ energy waveforms that are designed for an intended effect,for example, to incapacitate sweat glands and/or to tighten tissue, andthe like. The energy delivered through energy window array 3213, whichas in FIG. 32a may be electrode termini, may be pulsed in order tocreate, as the TMT is in motion, intermittent islands of undamagedtissue to feed and nourish the damaged tissue areas back to health. Forexample, the electrosurgical generator may be programmed to deliver 120watts of ‘coag’ energy with a 40% duty cycle of 80 ms ON and 120 ms OFF.These settings might seem high if they were considered to be applied toa high density discharge device such as a bovie needle tip or a boviepaddle. However, 120 watts of ‘coag’ power pulsed at a 40% duty cycleapplied over 6 termini may yield an energy distribution per electrodetermini of under 8 watts.

In some embodiments, each of the energy window/termini 3213′ may becoupled with one another and with a common energy source so as to eachdeliver the modality of energy. Alternatively, one or more of the energywindows/termini 3213′ may be isolated both physically and electricallyand/or otherwise energetically such that different modalities of energymay be created and/or delivered through each window/termini as desired.

In alternative embodiments, TMT 3211 may be configured to befree-floating and couple with a grasping/control instrument as disclosedin FIGS. 33a-f . Although, as discussed below, energy window 3312 doesnot comprise termini, this energy window may be replaced with energywindow termini as shown in FIG. 32a . Similarly, the energy windowtermini shown in FIG. 32a , may be replaced with the bar energy window3312 as depicted in FIG. 33a -f.

System 3200 may comprise canal(s) 3204 which may be positioned to supplyone or more fluids to the surgical site around or near TMT 3211 via aport located adjacent to the internal device cannula and/or lysing tip(show in FIG. 32a only). Canal 3204 may be configured to be extended andwithdrawn as needed. In alternative embodiments, other fluids that maypass down canal 3204 may include, but not be limited to, cold nitrogengas, fluorocarbons, etc., which might cool and/or freeze tissue to alterit in a desired fashion.

FIG. 33 depicts a TMT system 3300 comprising a free-floating tissuemodification tip (TMT) 3311 that may couple to grasping/controlinstrument 3391. In this embodiment, grasping tab 3318 may be coupled toone or more energy windows 3312 that may be positioned to face an upperand/or lower tissue plane that may have already been lysed/dissected.Cover 3313 may have one or more windows 3313′ that may comprise one ormore bars 3305 or other structural elements configured to separate anelongated energy window 3312 into a plurality of isolated energywindows. Although elongated energy window 3312 is in the shape of a bar,a wide variety of alternative shapes and sizes of energy windows and/orstructures for defining emission regions of energy windows may beprovided as desired. In some embodiments, cover 3313 may be formed witha plurality of circular openings such that elongated energy window 3312may be functionally similar or equivalent to the energy windows depictedin FIG. 32. Cover 3313 may be over-molded onto baseplate 3315. Inalternative embodiments, the region of energy window 3312 may compriseone or more (a plurality of) energy emitters positioned in a manner tooptimize the intended tissue modification effect. Grasping tab 3318 maybe coupled with a grasping/control instrument through which energy mayflow through to energy window 3312. Grasping tab 3318 may be coupled atthe receiving slot 3397 between upper and lower jaws 3393/3394respectively.

For example as shown in FIG. 33a , energy conduit 3309 may be coupledwith TMT 3311. Such an energy conduit may extend from energy window 3312and through, for example, grasping tab 3318 or otherwise through baseplate 3315 of TMT 3311. Energy conduit 3309 may in some embodimentsextend through an opening and/or tunnel formed in grasping/controlinstrument 3391. Alternatively, energy conduit 3309 may extend from TMT3311 up through a cannula (not shown) through which grasping controlinstrument 3391 may be delivered.

In alternative embodiments, the TMT system 3300 may be configured in anymanner to accommodate the delivery or creation of any energy modalityincluding, but not limited to, laser, intense pulse light, resistiveheating, radiant heat, thermochromic, ultrasound, mechanical, and/ormicrowave. In some embodiments, the particular type of energy may begenerated away from the TMT device and delivered to the TMT tip 3311 viaone or more conduits 3309. Alternatively, the TMT or the assemblysupporting the TMT may contain components for example, at or near energywindow conduit 3315, that when activated with another energy, forexample, AC and/or DC power and/or laser, may generate the desiredenergy type at the TMT energy window 3312. In some embodiments, theseenergy modalities may be delivered through or components that generate aparticular energy type in TMT 3311 powered through grasping tab 3318,which energy may be delivered into/onto the one or more energy windows3312. In some embodiments, such energy may be delivered by providing oneor more energy delivery conduits such as 3309.

A tip energy window tongue 3319 may be formed in tip 3311. For example,tip energy window conduit(s) 3304 m may terminate at a proximal end of agrasping pad 3318. Alternatively, a tongue or the like may be formed ina grasping/control instrument and configured to be received in acorresponding slot/conduit formed in tip 3311. A correspondinginstrument 3391′ energy window slot or conduit(s) 3304 f may terminatewithin one or both jaws 3393/3394 or within instrument 3991′ (lower jaw3394 is not shown to facilitate viewing of other components). Thus, oncejaws 3393/3394 have grasped or is about to grasp grasping pad 3318, theone or more energy-related conduits 3304/3304 a may be aligned to allowfor delivery of a desired form of energy therethrough. In someembodiments, a portion of one or both of the energy window conduits mayprotrude from either the tip or the instrument such that the protrudingportion may be received in a corresponding female portion of the energywindow conduit to form a secure connection. Thus, in the depictedembodiment, protruding tongue 3319 extends from the proximal portion ofgrasping pad 3318 and is configured to be received within a distalportion of instrument energy window conduit 3304 f formed within adistal portion of instrument 3391′ adjacent to jaws 3393/3394 and/orreceiving slot 3397 of grasper 3391′.

In the depicted embodiment, 3347 represents an antenna configured todeliver a signal to a receiver unit. Antennae 3347 may be located withinhole 3355 b. In some embodiments, antenna 3347 may compriseradiofrequency identification (RFID) TAG. In some embodiments the RFIDtag may comprise an RFID transponder. In other embodiments the RFID tagmay comprise a passive tag. It should be understood that antenna 3347 isnot depicted in every one of the other figures; any of the embodimentsdescribed herein may comprise one or more such elements. Otherembodiments may comprise one or more antenna on any other suitablelocation on the embodiment, including but not limited to on the TMT orgrasper tip or shaft. In embodiments in which antenna 3347 comprises anRFID transponder, the RFID transponder may comprise a microchip, such asa microchip having a rewritable memory. In some embodiments, the tag maymeasure less than a few millimeters. In some embodiments a reader maygenerate an alternating electromagnetic field which activates the RFIDtransponder and data may be sent via frequency modulation. In anembodiment, the position of the RFID tag or other antenna may bedetermined by an alternating electromagnetic field in the ultra-highfrequency range. The position may be related to a 3 dimensional mappingof the subject. In an embodiment the reader may generate an alternatingelectromagnetic field. One or more receiver units may be set up toreceive the signal from the tag. By evaluating, for example, thestrength of the signal at various receiver units, the distances from thevarious receiver units may be determined. By so determining suchdistances, a precise location of the lysing tip relative to a patientand/or a particular organ or other surgical site on the patient may bedetermined. In some embodiments, a display screen with appropriatesoftware may be coupled with the RFID or other localization technologyto allow a surgeon to visualize at least an approximate location of thetag/antenna, and therefore the lysing tip, relative to the patient'sbody.

Some embodiments may be further configured such that data from theantenna(s) may be used in connection with sensor data from the device.For example, some embodiments comprising one or more sensors 3348 may befurther coupled with one or more RFID tags. One or more sensors 3348 maybe located within one or more holes 3355 a or may be located on anyother suitable location on the embodiment, including but not limited toon the TMT or grasper tip or shaft. As such, data from the one or moresensors may be paired or otherwise used in connection with data from theone or more RFID tags or other antennas. For example, some embodimentsmay be configured to provide information to a surgeon regarding one ormore locations on the body from which one or more sensor readings wereobtained. In some embodiments, temperature sensors may includethermistors and/or thermocouples. To further illustrate using anotherexample, information regarding tissue temperature may be combined with alocation from which such tissue temperature(s) were taken. In thismanner, a surgeon may be provided with specific information regardingwhich locations within a patient's body have already been treated in aneffective manner and thus which locations need not receive furthertreatment using the device.

In some such embodiments, a visual display may be provided comprising animage of the patient's body and/or one or more selected regions of apatient's body. Such a system may be configured so as to provide avisual indication for one or more regions within the image correspondingto regions of the patient's tissue that have been sufficiently treated.For example, a display of a patient's liver may change colors atlocations on the display that correspond with regions of the liver thathave experienced a sufficient degree of fibrosis or other treatment.Such regions may, in some embodiments, be configured such that pixelscorresponding to particular regions only light up after thecorresponding tissue in that region reaches a particular thresholdtemperature.

Such sensor 3348 may be coupled with an antenna, which may send and/orreceive one or more signals to/from a processing unit. Alternatively, oradditionally, data from such sensors resulting from tissue and/or fluidanalysis using such sensors may be stored locally and transmitted later.As yet another alternative, such a signal may be transmitted followingsurgery. In such implementations, the signals need not necessarily betransmitted wirelessly. In fact, some embodiments may be configured tostore data locally, after which a data module, such as a memory stick,may be removed from the device and uploaded to a separate computer foranalysis.

In alternative embodiments which may be helpful for skin/cosmeticprocedures, the TD tip and/or the anticipated and/or previous paths maybe visualized using for example an internal camera such as an endoscopicor laparoscopic camera, and/or an external camera such as an infraredcamera, (for example, a FLIR camera), an RFID tag or other antenna. Insome implementations, such a device or devices may be positioned on theTD. In other implementations such a device or devices may be separatefrom the TD. A real time display may be created using the data of thecameras and/or antennae and/or tags, for example, showing the exactlocation of the tip and the during- and post-passage temperatureeffects. In alternative embodiments, the software presenting the visualinformation may hold (or slow the decay back to the body temperature)the color (designating temperature) at its maximum value during theremainder of the procedure so that the surgeon will know where the TDtip has been.

In some embodiments, the modular TMT 3311 may be used in a surgicalprocedure similar to that shown in FIGS. 35a-f . In such embodiments, itmay be helpful to form a protrusion on the top and/or bottom of tab3318. This may allow for rotation of TMT 3311 while it is in the jaws ofa suitable instrument 3314 g/3390 similar to engagement betweenprotrusions 3570 t′ and 3570 b′ with jaws 3593 and 3594 respectively asdepicted in FIG. 35a -35 f.

FIGS. 34a-34i comprises dissector/tissue clamp system (D-TC) 3400 thatis configured to be deployed through cannula 3432 in a deploymentconfiguration in which two opposing portions 3405 a/3406 a of D-TC tip3410 extend substantially parallel to the axis of cannula 3432. Moreparticularly in the depicted embodiment D-TC tip 3410 comprises a firstportion 3405 a that nests with a second portion 3406 a in the deploymentconfiguration. First portion 3405 a is configured to pivot with respectto second portion 3406 a when D-TC tip 3410 is reconfigured from itsdeployment (also a treatment-clamping configuration) to one of its othertreatment configurations. The deployment configuration is depicted inFIGS. 34c /34 d. A first treatment configuration is shown in FIG. 34a ;this treatment configuration may be referred to herein astreatment-dissecting configuration which may correspond with treatmentconfigurations of other embodiments previously described. A secondintermediate treatment configuration is shown in FIG. 34b ; in thisconfiguration, two tip portions 3405 a/3406 a are angled with respect toone another to prepare for capturing a vessel and/or duct 8. A thirdtreatment configuration is shown in FIG. 34c ; in this configuration,the duct and/or vessel 8 may be clamped in between the two tip portions(not shown). After performing this treatment, the D-TC tip 3410 may bewithdrawn into cannula 3432 in this same configuration after theduct/vessel 8 has been severed. Thus, the configuration depicted in FIG.34c may also be considered a deployment configuration once theduct/vessel 8 has been severed. FIG. 34b depicts D-TC tip 3410 as it isbeing reconfigured between deployment and treatment configurations orvice versa. As previously described, this intermediate configuration mayalso be considered a treatment configuration. For example, theconfiguration depicted in FIG. 34b may be used to treat tissuepositioned adjacent to one or both of the tip portions 3405 a/3406 awithout clamping/closing the jaws completely in some implementations.The pivoting of the tip portions 3405 a/3406 a may be done by using oneor more control arms. In the depicted embodiment, the first control arm3420 may be coupled at a pivot point 3420′ between first portion 3405 aand second portion 3406 a. Thus, by advancing or retracting control arm3420, first portion 3405 a and second portion 3406 a may be open andclosed like jaws. Additional control arms may be used in someembodiments to passively control the positioning of the two tipportions. Thus, upper control arm 3421 may be pivotably coupled withfirst portion 3405 a and lower control arm 3422 may be coupled withsecond portion 3406 a. Upper and lower control arms 3421 and 3422respectively may be pivotably coupled at their opposite ends at pivotbase 3420′ coupled to the inner sides of each first and second portion3405 a/3406 a. The active control arm 3420 may extend through theinner/device cannula 3431 and may be manually controlled by a surgeon.In some embodiments, the active control arm 3420 may be operably coupledwith an actuation component such as a control handpiece.

As depicted in FIG. 34f , first portion 3405 a and second portion 3406 amay comprise nonconductive covering 3405 b and 3406 b respectively whicheach are configured to receive electrode 3405 e and 3406 e respectivelyand their electrode segment(s). Pivot 7 and 7′ in the electrodes offirst portion 3405 a and second portion 3406 a may be coupled to controlarm 3420. Additionally, pivots 3416 and 3416′ positioned on electrodes3405 e/3406 e may be coupled with upper control arm 3421 and lowercontrol arm 3422 respectively. FIG. 34g depicts a rear view of allcomponents coupled together.

In an example of a method for treating tissue using the system of FIGS.34a-34i , the D-TC tip 3410 may first be delivered through cannula 3432in its delivery configuration as shown in FIG. 34d . D-TC tip 3410 maythen be advanced through the distal end of cannula 3432 as shown in FIG.34c . The opposing portions or jaws of the D-TC tip 3405 a/3406 a maythen be opened or at least partially opened as in FIG. 34b . If it isdesired to use D-TC tip 3410 as a dissector/lysing tip, the opposingportions 3405 a/3406 a may be fully opened such that they are alignedperpendicular to or at least substantially perpendicular to the axis ofthe cannula as shown in FIG. 34a . D-TC tip 3410 may then be used in anyof the procedures as previously described. If, on the other hand, it isdesired to use D-TC tip 3410 in order to clamp/seal a blood vessel orduct 8, the open opposing jaws 3405 a/3406 a may be positioned about ablood vessel or duct 8 (as shown in FIG. 34b ). In some suchimplementations, the opposing tip portions 3405 a/3406 a may not befully opened as shown in FIG. 34a . The opposing jaws 3405 a/3406 a maythen be at least partially closed onto the blood vessel or duct 8 inorder to clamp the blood vessel and then electro-cut/electro-coagulatethe blood vessel or duct 8 into opposing severed ends and/or acrushed/coagulated central portion of the blood vessel with opposingends.

FIG. 34h depicts a bipolar embodiment of system 3400 that includes theD-TC tip 3410 b. Upper portion 3405 a′ is configured to be electricallyisolated from lower portion 3406 a′ including the control arm 3420 b andmiddle hinge 3420 b′. Upper portion 3405 a′ is coupled to energy conduit3468 n while lower portion 3406 a′ is coupled to energy conduit 3468 p.Energy conduits 3468 n/3468 p may lead proximally and may enter and exitthrough holes 3431 h in inner device cannula 3431. D-TC tip 3410 b maybe used in its open/treatment configuration as shown in FIG. 34h todissect tissues and tissue planes. When upper and lower portions 3405 a′and 3406 a′ are in the closed or substantially closed position as shownin FIGS. 34b /34 c, system 3400 may be used to clamp/seal a blood vesselor duct.

FIG. 34i depicts an alternative embodiment that is similar to theembodiment depicted in FIG. 34h , however, it is configured such thatevery other lysing segment may be of a polarity opposite to the polarityof its adjacent lysing segment at any one time. In some embodiments,each of 5 lysing segments 3403 a-3403 e may be electrically isolatedfrom one another. Energy conduit 3468 n′ may be electrically coupled to2 lysing segments 3403 b/3403 d while energy conduit 3468 p′ may beelectrically coupled to 3 lysing segments 3403 a/3403 c/3403 e.

FIGS. 35a-35f depict yet another embodiment of a CDTD system 3500.However, as previously mentioned, other embodiments are contemplated inwhich system 3500 need not utilize a cannula and therefore may beconsidered a non-CDTD system. System 3500 comprises a lysing tip 3510that is configured to be completely separable from any other element ofthe system and may therefore be referred to herein as a “free-floating”lysing tip. Lysing tip 3510 may comprise a plurality of beads 3551 a-dand recessions 3502 between each bead pair. Lysing member 3560 (notvisible, as covered by spacers 3561 a/b/c), which in the depictedembodiment comprises a lysing rod 3560, is enclosed or may be partiallyenclosed by spacers 3561 a/3561 b/3561 c positioned in recessions 3502,as previously described. Each of the portions of lysing member 3560extending between adjacent beads 3551 a/b/c/d defines a lysing segment.

As also previously mentioned, a grasping/control instrument 3590 mayextend through a cannula 3532 to allow for grasping and/or control oflysing tip 3510 during an electrosurgical procedure. Grasping/controlinstrument 3590 may comprise one or more jaws configured to couple withsupport member 3570. As previously mentioned, in the depictedembodiment, support member 3570 comprises a bow shape extending betweenopposing ends of the support member 3570 and is coupled with lysingmember/rod 3560 at or near such opposing ends.

In the depicted embodiment, grasping/control instrument 3590 comprisesan upper jaw 3593 and a lower jaw 3594. One or both of these jaws maycomprise a projection or opening configured to facilitate coupling withlysing tip 3510 by way of a mating opening/projection formed on thelysing tip 3510. Thus, support member 3570 comprises an upper projection3570 t′ and a lower projection 3570 b′. One or both of these projectionsmay comprise a faceted and/or keyed shape to facilitate coupling oflysing tip 3510 with instrument 3590 in a particular rotationalorientation. Preferably, this shape allows for repositioning of lysingtip 3510 at any of a plurality of preconfigured rotational positions.Thus, as shown in FIG. 35d , upper projection 3570 t′ comprises aplurality of flattened or faceted surfaces that may mate with acorresponding plurality of flattened or faceted surfaces formed withinan opening 3593 h formed in a lower surface of upper jaw 3593. A varietyof alternative non-circular projection/opening pair shapes will beapparent to those of ordinary skill in the art after having received thebenefit of this disclosure.

In some embodiments, one of the projection/opening pairs may beconfigured to lock the lysing tip in a particular rotational orientationand the other may be configured to allow the lysing tip to rotate whilethe projection is seated within the opening. For example, as also shownin FIG. 35d , lower projection 3570 b′ may comprise a rounded and/orsmooth shape to allow for rotation when positioned within acorresponding opening (not shown in the figures) formed within an uppersurface of lower jaw 3594. By providing one projection/opening pair thatallows for rotation and another than locks the lysing tip in aparticular rotational orientation, a surgeon may be able to release thelocking projection/opening coupling while maintaining the rotatingprojection/opening pair coupling, rotate the lysing tip, and thenre-lock the lysing tip in a different rotational orientation withoutcompletely releasing the lysing tip from the instrument.

However, a wide variety of alternative embodiments are contemplated. Forexample, although the protrusions are depicted in FIGS. 35a-35f asformed on the lysing tip 3510, in alternative embodiments they mayinstead be formed on the grasping/control instrument 3590 and theopenings instead formed on the lysing tip 3510. In addition, a singleprojection/opening pair may be used instead of two separate pairs insome contemplated embodiments. In addition, in some embodiments, thelysing tip 3510 may be configured to rotate while fully grasped byinstrument 3590. In other words, both protrusion/opening pairs may bespherical and/or rounded or only a single such protrusion/opening may beused.

In an alternative embodiment, protrusions 3570 t′ and 3570 b′ may belocated toward the side of support member 3570′ thus allowing a sharperangle between the axis of the lysing tip and the axis of thegrasper/control instrument. Thus, the combined system may yield asmaller cross section during the deployment configuration through acannula.

Yet another embodiment of a free-floating lysing tip 3610 is depicted inFIGS. 36a-36e . This embodiment again comprises a plurality of beads3650 extending along a lysing member 3660 comprising a lysing rod.However, the beads 3651 a and 3651 b are positioned in between opposing,fixed protrusions 3676 a and 3676 b formed at opposite ends of lysingmember 3660. As best seen in FIG. 36d , protrusions 3676 a and 3676 bare fixedly coupled with or, in some embodiments, an integral part of,support member 3670 at opposing ends of support member 3670. Thus,although inner beads 3651 a and 3651 b may be configured to rotate, atleast partially, with respect to lysing member 3660 and/or lysing tip3610, outer protrusions 3676 a and 3676 b may instead be fixed.

As previously described, a plurality of spacers 3661 a, 3661 b, and 3661c may be positioned in between each adjacent protrusion (such protrusioneither being a bead or a fixed protrusion) along lysing tip 3610. Inaddition, opposing ends of lysing member 3660 may be formed withcoupling tips 3664 to facilitate coupling of lysing member 3660 withouter protrusions 3676 a and 3676 b.

Coupling tips 3664 may have diameters larger than the inner diameter oftheir corresponding tunnels 3673 in outer protrusions 3676 a/3676 brespectively. The coupling tips 3664 may take various shapes, such as aball, as depicted in FIG. 36b or, for example, a mushroom cap. In thedepicted embodiment, both of outer protrusions 3676 a/3676 b comprises arecess 3670′ that may have a larger diameter or other largest dimensionthan tunnels 3673 so as to accommodate/seat coupling tips 3664. Couplingtips 3664 may be made by, for example, liquefying the ends of lysingmember 3660 by LASER and/or other heating methods. Alternatively,coupling tips 3664 may comprise separate structural elements, such asscrew-on nuts or the like. In some embodiments, it may be desirable toprovide features and/or elements that inhibit or limit the ability ofthe electrosurgical energy to discharge from the opposing ends of thelysing rod. Thus, in some such embodiments, coupling tips 3664 may becoated or covered with a suitable insulating material such as an epoxywith non-conductive properties.

Although in the depicted embodiment, outer protrusions 3676 a/3676 b arefixedly attached to support member 3670, it is contemplated that theseprotrusions may, in some alternative embodiments, be converted to beadsby using bead structures that are loosely coupled with the ends ofsupport member 3670 so as to provide for space in between thesestructures and support member 3670 so as to allow for a predeterminedamount of rotation of these outer protrusions/beads, similar to innerbeads 3651 a/3651 b.

Still another example of a free-floating lysing tip 3710 according toother embodiments is depicted in FIGS. 37a-37e . In this embodiment,both of outer beads 3751 a/3751 d comprise an inner recess 3758 r toallow for respective opposing portions of support member 3770 to nesttherein. This configuration may be useful to prevent the opposing tipsof support member 3770 from discharging electrosurgical energy in anundesirable manner because these tips are nested within outer beads 3751a and 3751 d. Although in the depicted embodiment opposing portions ofsupport member 3770 are configured to be tightly or rigidly receivedwithin recesses 3758 r, alternative embodiments are contemplated inwhich one or both of these recesses may be formed slightly larger thantheir respective support member 3770 arms to allow for a predeterminedamount of rotation. For example, by adjusting the “height” of recesses3758 r (defined between upper and lower surfaces of lysing tip 3710perpendicular to the length of outer beads 3751 a and 3751 d betweentheir respective leading and trailing ends), rotation may be allowedalong an axis defined by lysing member 3760. However, by adjusting thelength and/or depth of recesses 3758 r, possibly along with thedimensions of the tunnels 3758 h formed therein, rotation along otheraxes may be permitted, such as rotation along an axis normal to the axisof the lysing member 3760 (resulting in swinging of the leading ends ofthe outer beads 3751 a and 3751 d to the left and right).

As previously described, a plurality of inner beads are also formedalong lysing member 3760, namely, inner beads 3751 b and 3751 c. Theseinner beads 3751 b and 3751 c comprise a flattened trailing endpositioned adjacent to a distal portion of support member 3770. As alsopreviously described, in some embodiments, the distance between supportmember 3770 and inner beads 3751 b and 3751 c may be selected so as toallow a predetermined amount of flexing of lysing member 3760 during anelectrosurgical procedure.

In addition, opposing ends of lysing member 3760 may be formed withcoupling tips 3764 to facilitate coupling of lysing member 3760 withouter beads 3751 a and 3751 d. Lysing member 3760 may extend throughtunnels 3758 h extending through outer beads 3751 a and 3751 d. As shownin FIG. 37e , on the outer side of outer beads 3751 a and 3751 d, asecondary recess and/or ledge 3751L may be formed so as to allowcoupling tips 3764 to be received within this recess and engage ledge3751L without entering tunnel 3758 h.

Finally, a plurality of spacers 3761 a, 3761 b, and 3761 c may bepositioned in between each adjacent bead along lysing tip 3710.

Another example of a free-floating lysing tip 3810 is shown in FIGS.38a-38c . Lysing tip 3810 is depicted coupled with a grasping/controlinstrument 3890 in FIG. 38a . Lysing tip 3810 comprises a plurality ofbeads 3851 positioned along a lysing rod 3860. Although each of beads3851 comprises a frusto-ellipsoidal shape having respective flattenedtrailing ends, any of the other bead shapes disclosed herein may besubstituted for these beads as desired in alternative embodiments.Lysing tip 3810 differs from the previously-described embodiments inthat lysing rod 3860 comprises opposing coupling tips 3869 configured tofacilitate coupling of lysing tip 3810 with one or two grasping/controlinstruments and corresponding holes or recesses 3891 h. For example,some embodiments may comprise a grasping/control instrument comprisingopposing arms 3890 a and 3890 b comprised of receiving holes or recesses3891 h at the distal ends which are configured to receive and capturelysing rod coupling tips 3869. Opposing arms 3890 a/3890 b may in someembodiments comprise jaws that may be selectively moveable relative toone another. Thus, a surgeon may open these arms/jaws to position themat opposite ends of lysing tip 3810 adjacent to coupling tips 3869 andthen close arms 3893 a/3893 b such that coupling tips 3869 may betrapped within a corresponding shaped hole and/or recess 3891 h placedin the tips of the jaws of one or more grasping instruments on closure.Alternatively, arms 3893/3894 may extend from distinct grasping controlinstruments that may use lysing tip 3810 to perform an electrosurgicalprocedure in unison.

FIG. 38b depicts a detailed view of the interface between modulargrasping instrument 3814 g, distal tip of shaft 3896 and pushrod 3897 ofa surgical instrument, and tip 3814 t together, the modular surgicaltool 3814. As shown in this figure the distal end of pushrod 3897 maycomprise a locking feature 3898. Locking lumen 3899′ comprises a slot3899 s configured to receive locking feature 3898 at a predeterminedrotational configuration. Upon aligning locking feature 3898 with slot3899 s, pushrod 3897 and shaft 3896 may be advanced into locking lumen3899′. After advancing pushrod 3897 to terminal end of slot, pushrod3897 and its accompanying pushrod locking feature 3899 n may be rotatedto lock pushrod locking feature 3899 n in place within locking chamber3899 n′. In some embodiments, the extent of the rotation of lockingfeature 3898 within locking feature chamber 3898′ and/or pushrod lockingfeature 3899 n may be the same as the extent of rotation of lockingfeature 3898 which may in some embodiments be 90 degrees. In someembodiments, pushrod locking feature 3899 n may comprise a plate or anelongated box or any other feature lacking rotational symmetry about theaxis pushrod 3897. Locking chamber 3899 n′ may comprise for example abox or other similar feature given to engage pushrod locking feature3899 n upon rotation of pushrod 3897.

Locking chamber 3899 n′ is coupled with coupling rod 3892 via holes 3877which in turn may be coupled with one or more locking teeth 3895 formedwithin one or both jaws 3893 a/3893 b. Thus, upon advancing orretracting pushrod 3897, coupling rod 3892 advances or retracts toadvance or retract locking tooth/teeth 3895 so as to fix in placesupport member 3870 within slot 3893 h of upper jaw 3893 a. One or bothof jaws 3893 a/3893 b may in some embodiments also be moveable withrespect to the other jaw. In some such embodiments, the moveable jaw orjaws may be manually opened to allow for receipt of support member 3870therein. The moveable jaw or jaws may then be closed and the lockingtooth/teeth 3895 actuated to lock the support member at a desiredrotational orientation such as a delivery configuration such as depictedin 38 c. Then upon retracting the lysing tip into a patient's body, thelocking tooth 3895 may be released to allow the lysing tip to be rotatedto a treatment configuration. Such rotation may be accomplished by, forexample, using an organ or another surgical instrument for leverage toreorient the lysing tip between delivery and treatment configurations.

As previously mentioned, in some embodiments, spacers 3861 may bepositioned in between each two adjacent beads 3851 to restrict the beads3851 to a confined region along lysing rod 3860 and/or limit orselectively facilitate rotation of the beads 3851 along lysing rod 3860.Although not depicted in the drawings, in some embodiments, outerspacers may be provided in between the two outer beads and theirrespective, adjacent coupling tip 3869. Alternatively, coupling tips3869 may be positioned to contact the outer surface of both outer beadsor the tunnels (not shown) extending through the outer beads and/or thediameter of the lysing rod 3860 may taper to provide for a suitablefriction fit between the outer beads and the lysing rod 3860.

In some implementations of methods for manufacturing the lysing rod 3810of FIGS. 38a and 38 b/c, lysing rod 3860 may initially comprise a wiredefining a cylindrical shape, or similar shape, along its entire length.Each of the various beads 3851 and, in some embodiments, spacers 3861 asneeded, may then be strung along lysing rod 3860 and positioned asdesired. Then, in order to form coupling tips 3869, opposing ends oflysing rod 3860 may be flattened and formed with a suitable hole and/ornotch as desired.

FIGS. 39a-39e depicts yet another example of a modular instrument/tip3900 configured to be coupled with a surgical instrument. Modularinstrument/tip 3900 comprises middle beads 3951 i and outer beads 39510coupled to lysing tip 3910 that may permanently couple with a modularinstrument shaft 3991. As previously described in connection with FIGS.17L and 17 m, modular instrument shaft 3991 may be reversibly coupledwith a surgical instrument at its distal end such as by using a pushrodand the locking elements previously described. Once this coupling hastaken place, a handle or suitable actuator may be used to reposition apiston 3917 p between a first configuration in which lysing tip islocked at a predetermined rotational configuration and a secondconfiguration in which the lysing tip is allowed to be repositioned atany of a plurality of rotational orientations. More particularly, in thesecond configuration, the support member 3970 of the lysing tip isloosely received within a hole 3997 formed at the distal end of modularinstrument shaft 3991. Thus, in this configuration, lysing tip can berotated to a delivery configuration as shown in FIG. 39d . Then, uponadvancing piston 3917 p, the lysing tip may be locked in this positionand delivered through an incision into a patient's body. After beingdelivered, piston 3917 p may be retracted to allow the support member toslide within hole 3997 and rotate the lysing tip to the treatmentconfiguration depicted in FIG. 39c after which the piston 3917 p may beadvanced to lock the lysing tip in this position for performing anelectrosurgical procedure.

As also shown in FIGS. 39d and 39e , some embodiments may be configuredto translate a proximal movement to a distal movement at or near thelysing tip. This may be useful for example to allow for a squeezingmotion of an instrument handle to be used to force an actuation membersuch as piston 3917 p′ distally rather than proximally so as to allow asurgeon to lock lysing tip 3910 in place at a desired rotationalorientation. For example in FIG. 39d , this may be accomplished with anlever mechanism which may comprise fulcrum 3918 f on which pivots lever3918 w which is pivotably attached to rods 3918 u and 3918L that eachconnect to distal piston 3917 p′ and proximal piston 3919 p′respectively. As another example in FIG. 39e , this motion translationmay be accomplished with a ratcheting mechanism which may comprisetoothed cog 3917 c positioned in between ratcheted rods 3917 u and3917L. Locking feature 3998 may reversibly couple with the distal tip ofa control instrument.

FIG. 40 depicts a flow chart of an optional implementation for the otherimplementations disclosed herein of an energy emission—sensor feedbackloop 4000 according to this disclosure: Step 4005 may comprise: settingone or more temperatures (a desired maximal temperature threshold, or arange). In other implementations one or more such temperatures may bepreset by the manufacturer. Step 4010 may comprise setting one or moreenergy levels to lysing member(s) of a TD and/or energy window of atissue modification tip (TMT) (a desired maximal energy threshold, or arange). In other implementations energy levels may be preset by themanufacturer.

Step 4013 comprises inserting the lysing tip through an entranceincision into the patient's body. In some implementations for example,step 4013 may comprise inserting the lysing tip via one or morecannulas. In some such implementations, the lysing tip may be deliveredthrough the cannula or cannulas in a delivery configuration and berotated/pivoted into a treatment configuration. Alternatively, thelysing tip may be inserted without using a cannula but instead agrasping/control instrument which may be a laparoscopic driver forexample. In the implementations comprising 2 cannulas, the inner andouter cannulas may be inserted through the entrance wound eithersimultaneously or sequentially. In some implementations, the lysing tipmay be free-floating such that it is inserted into the body and thencoupled with grasping/control instrument after being positioned in thebody. It should be understood that embodiments are contemplated whereinthe dimensions of the tip relative to a cannula 1431 may vary as forexample, as shown in FIGS. 14k and 14L. In other words, the lysing tip1410 in the axial deployment configuration may be unable to be receivedwithin cannula 1431 such as shown in FIG. 16L or may be unable to bereceived within an inner cannula of two delivery cannulas as shown inFIG. 16k . In embodiments comprising two cannulas, this may be usefulbecause if the lysing tip does not require substantial protection andcan remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only need to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Upon detecting that the tip has been rotatedto its treatment configuration, actuating the temperature sensors and/ortemperature feedback loop.

Step 4015 may comprise passing the TD or TMT through the target tissuearea. In some implementations, the TD and/or TMT may comprise one ormore sensors, such as temperature sensors. Alternatively or in addition,the sensor may be mounted in a position that always remains external topatient yet able to sense a residual energy release from the TD or TMTthrough tissue. Step 4020 may comprise applying electrosurgical energy.For example, in some implementations, electrosurgical energy may beapplied to one or more lysing members. In other implementations,electrosurgical energy may be applied to one or more energy windows. Insome implementations, such energy may be applied to both the lysingmembers and/or the energy window either simultaneously or sequentially.Step 4025 may comprise gathering sensor data, such as temperature data.Step 4030 may comprise comparing sensor data to one or more settemperature levels. Step 4035 may comprise, if the sensed temperatureexceeds the threshold, reducing the amount of energy delivered throughthe lysing member and/or TMT.

FIG. 41 depicts a flow chart of an implementation of a method forseparating and/or modifying tissue using a TD. In this particularimplementation, the use of combined data from the TD generated from atleast the temperature sensor and the antenna(s) may be used to providesuitable feedback to a user during treatment. In some implementations,the TD Wand may comprise a tip comprising a plurality of protrusions.One or more lysing member(s) may be positioned between at least twoadjacent protrusions among the plurality of protrusions. A temperaturesensor may be positioned on the TD. The temperature sensor may beconfigured to sense a temperature of at least one of tissue and fluidadjacent to the TD during an operation. The fluid of which a temperaturereading is taken may comprise, for example, fluid from adjacenttissue(s) and/or fluid introduced during the procedure by way of the TDand/or another device or procedure. The TD may also comprise anantenna(s) such as an RFID tag positioned on the TD. In someimplementations, the antenna(s) may be positioned on the tip and/ordistal end of the shaft, such as on a bottom surface of the tip and/ordistal end of the shaft. The antenna(s) may be configured to providelocation data regarding a location of the TD, such as a particularportion or region of the TD for example, during an operation orprocedure. Although method 4100 is shown in the figure beginning withstep 4105, it should be understood that any of the preliminary stepsdescribed above in connection with other implementations may beperformed in method 4100 as well. For example, one or more of steps(4005-4035) from method 4000 may be performed in method 4100 if desired.In some implementations, step 4105 may comprise: receiving data from theTD temperature sensor and/or a sensor not mounted on the TD but perhapsexternal to the patient. Step 4110 may comprise receiving data from theantenna(s) such as RFID tag data. Step 4115 may comprise combining thedata generated from at least the temperature sensor and the antenna(s).In some implementations, the data from the temperature sensor and theantenna(s) may be combined before it is received. In other words, a stepof “receiving combined data from the TD generated from at least thetemperature sensor and the antenna(s)” may comprise receivingprecombined data (data from the temperature sensor and the antenna(s)that was combined before it was received) or, alternatively, maycomprise separately receiving temperature data and antenna(s) data thatmay be combined to allow for one or more particular features orfunctionalities. The combined data may be used to allow a surgeon orother user to determine one or more regions within a patient's body thathave been adequately treated using the TD. For example, in someimplementations, the combined data may allow a user to visualize one ormore regions within a patient's body, such as one or more regions thathave been sufficiently treated. This may be accomplished, for example,by creating an image corresponding with one or more regions of apatient's body. Such image or images may be highlighted, receive colorchanges, or otherwise modified on a display to indicate to the userwhich regions have been adequately treated. In some implementations,such regions may correspond with regions comprising tissue that hasreached a predetermined threshold temperature.

One implementation of a method 4200 according to this disclosure foraccessing an organ and/or target tissue with the assistance of a TD isshown in FIG. 42. In some implementations, surgeon(s) may need to accesstissue and/or an organ to repair or treat it. In some implementations,the skin surrounding the anticipated entrance wound for the surgicalarea may be cleansed by, for example, with isopropyl alcohol (degreaser)followed by germicidal chlorhexidine scrub. Then, a local anesthetic maybe applied (such as by injecting) 1% lidocaine+1:10,000 adrenaline tothe skin. Although method 4200 is shown in the figure beginning withstep 4205, it should be understood that any of the preliminary and latersteps described above in connection with other implementations and/ormethods 4000 and 4100 may be performed in method 4200 as well. Forexample, one or more other steps of any of the other implementationsdescribed herein such as for example, steps 4005-4035 of the methoddepicted in FIG. 40 and/or steps 4105-4140 of the method depicted inFIG. 41 may also be included in the method depicted in FIG. 42.

Step 4205 may comprise, for minimally invasive procedures or minimallyinvasive entrance wounds, performing a limited incision capable ofaccommodating the most minimal dimension of a tip that will pass and/orcannula that will pass into the entrance incision For example, aspreviously discussed, the incision may have a length that is the same orsubstantially the same or slightly larger than the width of the tipand/or the diameter of the cannula. Step 4205 may be performed with, forexample, a #15 Bard-Parker™ Scalpel. This incision may be deepened byscalpel, scissors or other surgical instrument to enter the desired bodystructure or cavity. For larger approaches, such as open abdominalsurgery or trauma surgery step 4205 may comprise the initial skinopening or body cavity opening steps of such a procedure. In someimplementations, step 4205 may comprise making the skin incision usingthe lysing member comprising lysing member(s) of the TD. Step 4210 maycomprise applying one or more fluids to the tissues. In someimplementations, step 4210 may comprise applying fluids to the targettissue(s). In some implementations, embodiments with canals that maycarry fluids may be used as described herein, for example, canal 304 ofFIG. 3a , and/or canal 1404 of FIG. 14d . In alternative embodiments,other fluids that may pass down canal 304 may include, but not belimited to, cold nitrogen gas, fluorocarbons, etc., which might cooland/or freeze tissue to alter it in a desired fashion. In someimplementations, step 4210 may comprise applying fluids to the tissuesto be traversed en route to the target tissue, in addition to, or as analternative to applying fluids directly to the target tissue(s). Thisstep may be performed using for example canals 304 or 1404 depicted inFIGS. 3a and 14d respectively. In some implementations, the fluid(s) maycomprise water. In some implementations, the fluid(s) may comprise anionic fluid, such as a saline solution. The fluid(s) may be applied tothe tissue via, for example, injection, or TD fluid port or via aseparate cannula or catheter or via pouring or via spray. In someimplementations, the fluid(s) may comprise an ionic fluid and ananesthetic, such as a tumescent anesthesia. Non-ionic fluids may be usedin other implementations; such fluids may become more ionic by diffusionof some of the patients' ions present in the surgical field. In someimplementations step 4210 may comprise applying one or more fluids thatserve as an ionic fluid, and/or an anesthetic, and/or adrenaline. Insome cutaneous implementations, the fluid(s) may comprise a Klein and orother tumescent formula. In some implementations, the Klein formula andamount used may be about 100 cc of Klein Formula with saline, 0.1%lidocaine, epinephrine 1:1,000,000, and NaHCO3 @5 meq/L. Those ofordinary skill in the art will appreciate that this step will mosttypically be followed in connection with procedures involving skintissues. Other procedures may not require performing this step.

Step 4213 comprises inserting the lysing tip through an entranceincision into the patient's body. In some implementations for example,step 4213 may comprise inserting the lysing tip via one or morecannulas. In some such implementations, the lysing tip may be deliveredthrough the cannula or cannulas in a delivery configuration and berotated/pivoted into a treatment configuration. Alternatively, thelysing tip may be inserted without using a cannula but instead agrasping/control instrument which may be a laparoscopic driver forexample. In the implementations comprising 2 cannulas, the inner andouter cannulas may be inserted through the entrance wound eithersimultaneously or sequentially. In some implementations, the lysing tipmay be free-floating such that it is inserted into the body and thencoupled with grasping/control instrument after being positioned in thebody. It should be understood that embodiments are contemplated whereinthe dimensions of the tip relative to a cannula may vary as for example,as shown in FIGS. 14k and 14L. In other words, the lysing tip 1410 inthe axial deployment configuration may be unable to be received withincannula 1431 such as shown in FIG. 14L or may be unable to be receivedwithin an inner cannula 1431 of two delivery cannulas 1431 and 1432, asshown in FIG. 14k . In embodiments comprising two cannulas, this may beuseful because if the lysing tip does not require substantial protectionand can remain outside the inner cannula's lumen, then the criticaldimensions of the lysing tip can correspond to the larger diameter outercannula as opposed to being limited to the smaller dimensions of theinner/device cannula. In embodiments comprising a single cannula, thismay be useful because if the lysing tip does not require substantialprotection and can remain outside the inner cannula's lumen, then thecritical dimensions of the lysing tip in its axial/deliveryconfiguration only needs to correspond to the size of the entranceincision. With respect to such embodiments, the single cannula mayprimarily serve to protect and stabilize the control rods and providerigidity to the assembly. Such embodiments may be useful for cosmeticprocedures within the skin, for example, but not limited to, for facelifting and/or cellulite treatment.

Step 4215 may comprise a first sub-step that may be to activate theelectrosurgical generator to cause cutting and/or a blend of cutting andcoagulation energies to flow to the lysing member(s). The secondsub-step may be passing the TD through the various layers of tissue tocreate a path to a target organ. In some implementations, creating apath to a target organ or other target tissue may comprise creating apath from the incision to the target organ or other target tissue and/orcreating a path around the target organ or other target tissue to allowfor access to other regions of the target organ or other target tissue.In some implementations, the lysing member(s) may be used to inducefibrosis along the path, including along a path that may traverse theperimeter of the target organ/tissue. In some implementations, the TDand/or the anticipated path may be visualized using for example aninternal camera such as an endoscopic or laparoscopic camera. In somecutaneous and/or cosmetic implementations, an external camera such as aFLIR camera, an RFID tag or other antenna may be used. In someimplementations, such a device or devices may be positioned on the TD.In other implementations such a device or devices may be separate fromthe TD. In some implementations, heat may be produced or energy mayotherwise be released in the tissues through which the TD is passed. Insome implementations, heating portions of the tissues the TD passes bymay be undesirable. As such, in some implementations, undesirableheating of such tissues and/or adjacent tissues may be mitigated byapplying a cooling step antecedent and or concurrent with energydelivery with the TD. Such steps may comprise use of one or more coolingfluids delivered via the TD or one or more separate catheters orcannulas or endoscopes. Other cooling mechanisms may comprise a dynamiccooling system wherein a cool liquid or gel is actively pumped into orthrough a contact cooling object. Step 4220 may comprise identifyingcritical tissue that is not to be treated, such as important bloodvessels, nerves, ducts, organs or other anatomy along the path to thetarget organ/tissue and/or in the area surrounding the targetorgan/tissue. Step 4225 may comprise: adding additional fluids of thetypes previously described to the target and/or surrounding tissues viathe TD port(s) or via one or more separate catheters or cannulas orendoscopes. Step 4230 may comprise: expanding one or more regions of thepath to the target tissue. In some implementations, step 4230 maycomprise expanding one or more path(s) from the incision to the targettissue. In some implementations, step 4230 may comprise expanding aregion around the target tissue such as for example, via a fanningmotion. In some implementations, one or more of the other stepsdescribed herein using the TD may also be performed with a fanningmotion. In implementations using TDs with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TDs with nonaxially oriented protrusions, such afanning motion may comprise a side-to-side fanning motion; one exampleof a fanning motion using a TD having at least one nonaxially orientedprotrusion may comprise a ‘windshield wiper’ motion. In someimplementations step 4230 may further comprise activating the energy tothe TD, for example, the energy to the lysing member(s). Alternatively,in some implementations, an additional step 4231 may be used comprisingwithdrawing the lysing tip and inserting and activating a TMT for adesired effect, for example, tissue modification/tightening. Step 4235may comprise: observing for bleeding from larger vessels and achievinghemostasis as needed. In some implementations achieving hemostasis maybe accomplished by cautery, electrifying, ligating, or chemical methods.In some implementations, the surgeon may activate the electrosurgicalcoagulation energy to the lysing member(s) to achieve the hemostasis. Insome implementations, one or more other devices and/or suture may beused to achieve hemostasis for larger vessels.

Generally, step 4238 may comprise withdrawing the lysing tip. Forexample, step 4238 may comprise rotating the lysing tip such that itextends axially along the lumen of the one or more cannulas or at leastsubstantially axial to such lumen(s). In some implementations the lysingtip may be rotated at an angle with respect to such lumen so long as thelysing tip can be withdrawn through this cannula in this configuration.After rotating the lysing tip sufficiently such that it can be receivedwithin the cannula or cannulas, the lysing tip may be withdrawn throughthe entrance incision.

In some implementations not utilizing a cannula, the lysing tippreferably is again rotated such that the elongated axis of the lysingtip is aligned or at least substantially aligned with the direction ofwithdrawal. After such rotation, the lysing tip may be withdrawn throughthe entrance incision. In some such implementations, a surgeon mayrotate the lysing tip by palpation. Alternatively, an instrument may beused to perform the rotation and may be used to withdraw the lysing tipthrough the entrance incision. As previously mentioned, in someimplementations, a first instrument may release its coupling with thelysing tip and then a second instrument may be used to rotate and/orwithdraw the lysing tip. In alternative implementations, a cord, forexample, a suture and/or thread, may have been previously tied to a holein the lysing tip and may be used to pull the lysing tip throughentrance incision.

Step 4240 may comprise: removing the TD with power off and suturing thewound in the standard fashion. In some implementations, the tissuestraversed may require closure by suturing, stapling, gluing, and/oradhesive skin closure strips. In some implementations, organs and/ororgan systems that the TD may be useful to access may include but notlimited to skin, muscle, and/or parotid, and/or salivary gland, and/orthyroid, and/or lung, and/or heart, and/or gastrointestinal, and/orliver, and/or pancreas, and/or spleen, and/or gallbladder, and/orkidney, and/or adrenal, and/or prostate, and/or ovary, and/or uterus,and/or bladder, and/or vascular, and/or nervous, and/or lymph nodesand/or skeleton.

In some implementations, the TD may also aid in the treatment of traumavictims; for example, gunshot and/or blast injuries and/blunt forcetrauma. Such patients may be in shock and bleed to a greater degree thannormal due to systemic changes, some changes of which may consume and/oralter platelets and/or clotting proteins in the blood. It may bebeneficial for surgeons to reach a vigorously bleeding area more rapidlywhile achieving a degree of hemostasis by coagulating smaller vesselsalong the path to reaching said vigorously bleeding area (likely due totrauma to a larger blood vessel). The TD may have smaller vesselhemostatic capabilities when energy is applied to lysing member. Havinga field of surgery with less bleeding may be beneficial to the surgeonwho is working to find and repair a larger blood vessel (for example, afemoral or brachial artery). The size of the TD's lysing areas may besuch that a larger vessel will not fit into the TD and thus not beaffected by the TD; thus, the surgeon may feel more confident that theTD will not risk traumatizing a larger blood vessel further.

In some implementations such as method 4300, the TD may also aid in thetreatment of hernias. Generally, herniated tissues are those that mayhave lost firmness and may have become lax allowing one or more organsto unwantedly protrude into adjacent spaces. To treat a hernia, surgeonsmay make paths to the site to be treated, may remove the lax hernia sacand/or other lax/herniated tissues by dissecting around said tissue(s),and may then connect/suture the edges of healthy tissue together tore-create the original healthy tissue wall, or, if insufficient healthytissue is present, may use mesh to connect the healthy tissue to formthe new tissue wall.

One implementation of a method 4300 according to this disclosure forrepairing hernias with the assistance of a TD is shown in FIG. 43.

Step 4331 may comprise making a path to the site of the herniatedtissue. Step 4331 may also comprise using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught theherniated tissues and/or associated fibrous tissues and/or thesurrounding tissue(s). Step 4331 may be performed using, for example,needles, sutures, hooks, clamps, retractors, probes, bars, endoscopes,rakes, tubes, and/or TD.

Step 4332 may comprise dissecting around the herniated tissue in orderto remove it or free up adjacent structural tissue so that the TD oranother instrument may cut/excise around the herniated tissues forremoval. In some implementations step 4331 may be performed concurrentlywith step 4332. Step 4332 may further comprise passing the TD to atleast substantially free or prepare for excision the herniated tissuesand/or associated fibrous tissues from the surrounding tissues. In someimplementations, step 4332 may further comprise applying energy to thelysing members during this TD passage.

Step 4333 may comprise excising and removing the herniated/lax tissuesand/or hernia sac.

Step 4334 may comprise heating the tissue surrounding the herniatedtissue and/or associated fibrous tissues and/or tissue(s) that a surgeonintends to incorporate into the region to secure and/or restrain theremaining tissue into its intended and/or original place. In someimplementations, step 4334 may be performed using the TD, either withlysing segments of the TD or an energy window. Alternatively, the TD maybe withdrawn and a TMT may be introduced having an energy window andused for this purpose.

Step 4335 may comprise (if further freeing/excision appears necessary)using additional instrumentation to put force upon and/or pull and/orstretch and/or make taught target tissue(s) while the TD may be passedto more uniformly apply energy to the target tissue via the lysingmember(s) of the lysing tip and/or via the Tissue Modification Tip (TMT)or other applicable device that may induce hemostasis and/or inducepostoperative fibrosis, and/or alter certain tissues.

Step 4336 may comprise sewing, stapling or binding the remaining tissuesand/or herniated tissues into place. If insufficient healthy tissue ispresent to form a proper intended tissue wall, mesh may be used tobridge the space between the healthy tissues.

Step 4337 may comprise passing the TD adjacent to those tissues thathave been sewn and/or otherwise bound. In some implementations, step4337 may comprise activation of the lysing member or activation of a TMTto induce supportive fibrosis.

In some implementations, organs and/or organ systems that the TD may beuseful to assist in remedying a herniated state may include but notlimited to muscle, and/or parotid, and/or salivary gland, and/orgastrointestinal, and/or uterus, and/or bladder, and/or vascular, and/orgenitourinary.

One implementation of a method 4400 according to this disclosure foraccessing the central nervous system (CNS) with the assistance of a TDis shown in FIG. 44. Although method 4400 is shown in the figurebeginning with step 4315, it should be understood that any of thepreliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 4400 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40, steps4105-4115 of the method depicted in FIG. 41, and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 44.

After preparing the surgical field, making the entrance incision, andintroducing the TD through the entrance incision, step 4415 may comprisemaking a path to the target tissue/organ. More particularly, inimplementations accessing the brain, step 4415 may comprise moving theTD through the subgaleal layer; this may allow the scalp to be retractedfor better access to open the skull via bone saw and/or other toolsknown in the art. In some implementations step 4415 may further compriseactivating the lysing member to reduce bleeding from emissary bloodvessels. In implementations accessing the spinal cord, step 4415 maycomprise moving the TD through tissue surrounding the spine. In someimplementations, such movement may comprise a fanning motion. Step 4420may comprise dissecting the dura using the TD and/or identifyingimportant blood vessels, and/or other anatomy in the area surroundingthe target tissue. Step 4425 may comprise: adding additional fluids ofthe types previously described to the target and/or surrounding tissuesvia the TD port(s) or via one or more separate catheters or cannulas orendoscopes prior to and/or during the application of energy by TD. Step4429 may comprise: activating the energy to the TD for example theenergy to the lysing member(s). Step 4430 may further comprise passingthe TD around and/or through the target tissue in the CNS such as forexample, via a delicate fanning motion. In some implementations, the TDand/or the anticipated path may be visualized using for example anendoscope, a fiberoptic or camera, an RFID tag or other antenna. In someimplementations, such a device or devices may be positioned on the TD.In other implementations such a device or devices may be separate fromthe TD. Step 4435 may comprise: observing for bleeding from largervessels and achieving hemostasis as needed. In some implementationsachieving hemostasis may be accomplished by cautery, electrifying,ligating, chemical methods, and/or use of a TMT. In someimplementations, the lysing member(s) can be used to achieve thehemostasis. In some implementations, one or more other devices and/orsuture may be used to achieve hemostasis for larger vessels. Step 4440may comprise: removing the TD with power off and suturing the wound inthe standard fashion.

One implementation of a method 4500 according to this disclosure forremoving tissue from a peripheral nerve such as for example tumor and/orscar tissue and/or fibrosis with the assistance of a TD is shown in FIG.40. Although method 4500 is shown in the figure beginning with step4531, it should be understood that any of the preliminary and latersteps described above in connection with other implementations and/ormethods and/or methods 4000, 4100, and 4200 may be performed in method4500 as well. For example, one or more of steps 4005-4035 in the methoddepicted in FIG. 40 may be performed in method 4500 if desired.Similarly, one or more other steps of any of the other implementationsdescribed herein such as for example, steps 4005-4045 of the methoddepicted in FIG. 40 may also be included in the method depicted in FIG.45.

Step 4531 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the nerve and/ortissue adjacent a peripheral nerve (such as for example tumor and/orscar tissue and/or fibrosis) and/or surrounding tissue(s). Step 4531 maybe performed using, for example, needles, sutures, hooks, clamps,retractors, probes, bars, endoscopes, rakes, tubes, TD and/or by hand.In some implementations step 4531 may be performed concurrently withstep 4532. Step 4532 may comprise passing the TD to at leastsubstantially free the tumor(s) and/or scar tissue and/or fibrosis fromthe nerve and/or surrounding tissues. In some preferred implementations,step 4532 may comprise passing the TD to free, or at leastsubstantially, free, the tumor(s) and/or scar tissue from the nerveand/or surrounding tissues without activating the lysing segments of theTD. In other words, because of the sensitive nature of nerve tissue, itmay be preferred to use the TD as a blunt dissector without usingelectrosurgical energy. However, additional related steps may involveuse of such energy. In addition, in alternative implementations, energymay be applied to the lysing members during this TD passage. Step 4533may comprise identifying and/or testing the tissue (such as for exampletumor and/or scar tissue and/or fibrosis) to determine if it has beensufficiently freed from the nerve and/or surrounding tissues foruncomplicated removal. In some implementations endoscopes and/or bluntprobes and/or TD and/or surgeon's hands may be passed around the tumorand/or scar tissue and/or fibrosis to test the degree of freedom thetumor and/or scar tissue and/or fibrosis has from the nerve and/orsurrounding tissues. Step 4534 may comprise (if further freeing appearsnecessary) using additional instrumentation to put force upon and/orpull and/or stretch and/or make taught the nerve and/or tumor and/orscar tissue and/or fibrosis. Step 4535 may comprise passing the TD tofurther free the nerve; energy may be applied to the lysing membersduring this TD passage (in order to attempt hemostasis and/or inducepostoperative fibrosis). Step 4535 may be repeated as necessary untilthe tumor and/or scar tissue and/or fibrosis is sufficiently freed forremoval. In an implementation the TD is passed longitudinally along thenerve in a ‘stripping’ fashion, such that a longitudinal axis of the TDis at least substantially parallel to a longitudinal axis of the nerveduring step 4533. The shape of certain embodiments of lysing tipsdescribed herein may be particularly useful in allowing the tip to bemoved along a nerve without causing undue damage to the nerve. Moreparticularly, by providing smooth protrusions and recessing thesharpened or electro-cutting portions of the tip between theprotrusions, the nerve may be protected from the cutting aspects of thedevice.

In an alternative implementation of method 4500, this method may bemodified to allow for dissection of tissues to repair an aneurism. Insuch an implementation, each of the steps up to 4532 may besubstantially identical to method 4500. Step 4532 may instead comprisedissecting vascular and connective tissues in and around the aneurismusing the TD. This step may also include sealing small peripheralbleeders from and around the aorta. Step 4533 may comprisedissecting/cutting a section or sectioning the aorta with the TD.

In another alternative implementation of method 4500, this method may bemodified to conduct a coronary artery bypass graft and/or other vasculargraft. In such an implementation, each of the steps up to 4532 may besubstantially identical to method 4500. Step 4532 may instead comprisedissecting out the saphenous vein from a leg or other suitable vessel(e.g., infra mammary). Step 4533 may comprise dissecting along thevessel to remove any adhesions and/or seal/disconnect small peripheryblood vessels that may bleed and/or seal small peripheral vessels.

One implementation of a method 4600 according to this disclosure forcreating a tissue flap and/or section with the assistance of a TD isshown in FIG. 46. (In this method 4600, the term ‘flap’ may include‘section’) In some implementations, such a flap of tissue may be usedfor breast reconstruction. In some implementations, such a flap oftissue is a latissimus dorsi flap. In some implementations, such a flapof tissue is a TRAM (Transverse Rectus Abdominus Myocutaneous) flap.Although method 4600 is shown in the figure beginning with step 4631, itshould be understood that any of the preliminary and later stepsdescribed above in connection with other implementations and/or methodsand/or methods 4000, 4100, and 4200 may be performed in method 4600 aswell. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40, steps 4105-4115 of the method depictedin FIG. 41, and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 46.

Step 4631 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the target region oftissue to be used in creating a tissue flap and/or the surroundingtissue(s). Step 4631 may be performed using, for example, needles,sutures, hooks, clamps, retractors, probes, bars, endoscopes, rakes,tubes, TD and/or by hand. In some implementations step 4631 may beperformed concurrently with step 4632. Step 4632 may comprise passingthe TD to at least substantially separate a sufficient amount of tissueto create and/or free at least a portion of the tissue flap. In someimplementations, step 4632 may further comprise applying energy to thelysing member(s) during this TD passage. Step 4633 may comprise testingthe target tissue flap to determine if it has been sufficiently freedfrom the surrounding tissues for uncomplicated removal (excluding itspedicle). In some implementations endoscopes and/or blunt probes and/orTD and/or surgeon's hands may be passed around the target organ/tissueto determine the degree of freedom a target flap and/or tissue has fromits surrounding tissues and/or organs. Step 4634 may comprise (iffurther freeing appears necessary) using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught the targetflap and/or tissue and/or other surrounding tissue while the TD may bepassed to further free the target flap and/or tissue; energy may beapplied to the lysing member(s) during this TD passage (in order toattempt hemostasis and/or induce postoperative fibrosis). Step 4635 maycomprise passing the TD (after the target flap and/or tissue has beenfreed and/or moved) to the tissues that were adjacent and remaining inthe body, which may aid the surgeon in examining for points of furtherbleeding and/or for further exploration; during such passage energy maybe applied to the lysing members (in order to attempt hemostasis and/orinduce postoperative fibrosis). In some implementations, traditionalinstruments may be used to achieve hemostasis. In some implementations,one or more of these steps using the TD may be performed with a fanningmotion. In implementations using TD's with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TD's with at least one nonaxially orientedprotrusion, such a fanning motion may comprise a side-to-side fanningmotion; one example of a fanning motion using a TD having at least onenonaxially oriented protrusion may comprise a ‘windshield wiper’ motion.In some implementations, the TD may be used to create flaps in and/orfrom tissues and/or organs including but not limited to muscle and/orfascia, and/or fibrous tissue and/or fat and/or vascular tissues. Insome implementations, the TD may be used to create flaps and/or sectionsin and/or from tissues and/or organs including but not limited to, lungand/or liver and/or gastrointestinal and/or genital/urinary and/oruterus and/or bladder.

One implementation of a method 4700 according to this disclosure forcreating a tissue graft with the assistance of a TD is shown in FIG. 47.In some implementations, such a graft of tissue may be used forreconstruction of traumatic wounds.

Although method 4700 is shown in the figure beginning with step 4731, itshould be understood that any of the preliminary and later stepsdescribed above in connection with other implementations and/or methodsand/or methods 4000, 4100, and 4200 may be performed in method 4700 aswell. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40, steps 4105-4115 of the method depictedin FIG. 41, and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 47.

Step 4731 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the target region oftissue to be used in creating a tissue graft and/or the surroundingtissue(s). Step 4731 may be performed using, for example, needles,sutures, hooks, clamps, retractors, probes, bars, endoscopes, rakes,tubes, TD and/or by hand. In some implementations step 4731 may beperformed concurrently with step 4732. Step 4732 may comprise passingthe TD to at least substantially separate a sufficient amount of tissueto create and/or free at least a portion of the tissue graft. In someimplementations, step 4732 may further comprise applying energy to thelysing members during this TD passage. Step 4733 may comprise testingthe target tissue graft to determine if it has been sufficiently freedfrom the surrounding tissues for uncomplicated removal. In someimplementations endoscopes and/or blunt probes and/or TD and/orsurgeon's hands may be passed around the target organ/tissue todetermine the degree of freedom a target graft and/or tissue has fromits surrounding tissues and/or organs. Step 4734 may comprise (iffurther freeing appears necessary) using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught the targetgraft and/or tissue and/or other surrounding tissue while the TD may bepassed to further free the target graft and/or tissue; energy may beapplied to the lysing members during this TD passage (in order toattempt hemostasis and/or induce postoperative fibrosis). Step 4735 maycomprise passing the TD (after the target graft and/or tissue has beenfreed and/or moved) to the tissues that were adjacent and remaining inthe body, which may aid the surgeon in examining for points of furtherbleeding and/or for further exploration; during such passage energy maybe applied to the lysing members (in order to attempt hemostasis and/orinduce postoperative fibrosis). In some implementations, traditionalinstruments may be used to achieve hemostasis. In some implementations,one or more of these steps using the TD may be performed with a fanningmotion. In implementations using TD's with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TD's with at least one nonaxially orientedprotrusion, such a fanning motion may comprise a side-to-side fanningmotion; one example of a fanning motion using a TD having at least onenonaxially oriented protrusion may comprise a ‘windshield wiper’ motion.In some implementations, the TD may be used to create grafts in and/orfrom tissues and/or organs including but not limited to skin and/ormucosal and/or fascia, and/or connective/fibrous tissue (for example,tendon) and/or fat and/or vascular tissues. In some implementations, theTD may be used to create grafts in and/or from tissues and/or organsincluding but not limited to, lung and/or liver and/or gastrointestinaland/or genital/urinary and/or uterus and/or bladder. In someimplementations, the TD may be used to harvest any or all of theaforementioned tissues for organ culture.

One implementation of a method 4800 according to this disclosure forremoving tumor from an organ with the assistance of a TD is shown inFIG. 48. In some implementations, the tumor may be incompletely removedto ‘debulk’ it and/or to prevent disease spread within the body and/orpathologic analysis. In some implementations, the tumor may becompletely removed to prevent disease spread within the body and/orpathologic analysis. Although method 4800 is shown in the figurebeginning with step 4831, it should be understood that any of thepreliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 4800 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40, steps4105-4115 of the method depicted in FIG. 41, and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 48.

Step 4831 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the tumor and/or thesurrounding tissue(s). Step 4831 may be performed using, for example,needles, sutures, hooks, clamps, retractors, probes, bars, endoscopes,rakes, tubes, TD and/or by hand. In some implementations, step 4831 maybe performed concurrently with step 4832. Step 4832 may comprise passingthe TD to at least substantially free the tumor(s) from the surroundingtissues. In some implementations, step 4832 may further compriseapplying energy to the lysing segments and/or energy windows during thisTD passage. Step 4833 may comprise identifying and/or testing the tumorto determine if it has been sufficiently freed from the surroundingtissues and/or organ for uncomplicated removal. In some implementationsendoscopes and/or blunt probes and/or TD and/or surgeon's hands may bepassed around the tumor to test the degree of freedom the tumor has fromits surrounding tissues and/or organs. Step 4834 may comprise (iffurther freeing appears necessary) using additional instrumentation toput force upon and/or pull and/or stretch and/or make taught the tumorand/or the surrounding tissue and/or organ while the TD may be passed tofurther free the tumor; energy may be applied to the lysing segmentsand/or energy windows during this TD passage (in order to attempthemostasis and/or induce postoperative fibrosis). In someimplementations, traditional instruments may be used to achievehemostasis. Step 4834 may be repeated as necessary until the tumor issufficiently freed for removal. Step 4835 may comprise passing the TD(after the tumor has been removed) to the tissues that were adjacent tothe tumor (and still remaining in the body), which may aid the surgeonin examining for points of further bleeding and/or for furtherexploration; during such TD passage, energy may be applied to the lysingsegments and/or energy windows. Step 4836 may comprise using the TD tosubdivide portions of the tumor which may aid in extracting the tumor inpieces if the surgery is done via a minimally invasive technique. Insome implementations, if the surgical incision in the body is larger,the tumor tissue may pass more freely out of the body without piecemealremoval. In some implementations, the tumor is placed in the appropriatemedium for a pathologist to examine or test. In some implementations,one or more of these steps using the TD may be performed with a fanningmotion. In implementations using TD's with axially oriented protrusions,such a fanning motion may comprise a to and fro spokewheel pattern. Inimplementations using TD's with at least one nonaxially orientedprotrusion, such a fanning motion may comprise a side-to-side fanningmotion; one example of a fanning motion using a TD having at least onenonaxially oriented protrusion may comprise a ‘windshield wiper’ motion.In some implementations, organs and/or organ systems that the TD may beuseful to remove tumors which may include but not limited to skin,and/or muscle, and/or fibrous tissues, and/or parotid, and/or salivarygland, and/or thyroid, and/or lung, and/or breast, and/or heart, and/ornervous system, and/or spleen, and/or gastrointestinal, and/or liver,and/or pancreas, and/or gallbladder, and/or genital/urinary, and/orkidney, and/or adrenal, and/or prostate, and/or ovary, and/or uterus,and/or bladder, and/or vascular, and/or lymph nodes and/or skeleton,and/or central nervous system, and/or peripheral nervous system and/orlung.

One implementation of a method 4900 according to this disclosure forremoving an organ with the assistance of a TD is shown in FIG. 49. Insome implementations, organ(s) may be removed from a donor to surgicallyimplant into a recipient patient. In some implementations, organ(s) maybe removed for disease and pathologic analysis. In some implementations,the donor may be the recipient patient (for example, a muscle graft).Although method 4900 is shown in the figure beginning with step 4931, itshould be understood that any of the preliminary and later stepsdescribed above in connection with other implementations and/or methodsand/or methods 4000, 4100, and 4200 may be performed in method 4900 aswell. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40, steps 4105-4115 of the method depictedin FIG. 41, and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 49.

Step 4931 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the target tissueand/or organ(s) and/or the surrounding tissue(s). Step 4931 may beperformed using, for example, needles, sutures, hooks, clamps,retractors, probes, bars, endoscopes, rakes, tubes, TD and/or by hand.In some implementations, step 4931 may be performed concurrently withstep 4932. Step 4932 may comprise passing the TD to at leastsubstantially free the organ(s) from the surrounding tissues. In someimplementations, step 4932 may further comprise applying energy to thetissues during this TD passage. Step 4933 may comprise testing thetarget tissue and/or organ to determine if it has been sufficientlyfreed from the surrounding tissues for uncomplicated removal. In someimplementations endoscopes and/or blunt probes and/or TD may be passedaround the target organ/tissue to determine the degree of freedom atarget tissue and/or organ has from its surrounding tissues and/ororgans. Step 4934 may comprise (if further freeing appears necessary)using additional instrumentation to put force upon and/or pull and/orstretch and/or make taught the target tissue and/or organ and/or thesurrounding tissue while the TD may be passed to further free the targettissue and/or organ; energy may be applied during this TD passage. Step4935 may comprise passing the TD (after the target tissue and/or organhas been removed) to the tissues that were adjacent and remaining in thebody, which may aid the surgeon in examining for points of furtherbleeding and/or for further exploration; during such passage energy maybe applied to the lysing member(s) (in order to attempt hemostasisand/or induce postoperative fibrosis). In some implementations,traditional instruments may be used to achieve hemostasis. Step 4936 maycomprise clamping and/or sealing critical ducts and/or blood vessels onthe target tissue and/or organ so that the target tissue and/or organmay be properly transferred to and/or transported to and/or stored forthe recipient patient if it is a donor organ. In some implementations,an organ may be cooled or refrigerated. In other implementations if thetarget tissue and/or organ is diseased, the tissue may be properlyplaced in the appropriate medium for a pathologist to examine or test.In some implementations, one or more of these steps using the TD may beperformed with a fanning motion. In implementations using TD's withaxially oriented protrusions, such a fanning motion may comprise a toand fro spokewheel pattern. In implementations using TD's with at leastone nonaxially oriented protrusion, such a fanning motion may comprise aside-to-side fanning motion; one example of a fanning motion using a TDhaving at least one nonaxially oriented protrusion may comprise a‘windshield wiper’ motion. In some implementations, organs and/or organsystems that the TD may be useful to remove may include but not limitedto skin, and/or fibrous tissues, and/or muscle, and/or parotid, and/orsalivary gland, and/or thyroid, and/or breast, and/or lung, and/orheart, and/or gastrointestinal, and/or liver, and/or pancreas, and/orspleen, and/or gallbladder, and/or kidney, and/or adrenal, and/orprostate, and/or ovary, and/or uterus, and/or bladder, and/or vascular,and/or lymph nodes and/or skeleton, and/or central nervous system,and/or peripheral nervous system.

One implementation of a method 5000 according to this disclosure forremoving and/or freeing target scar tissue and/or fibrosis (or anotherfibrous tissue) from an organ with the assistance of a TD is shown inFIG. 50. Although method 5000 is shown in the figure beginning with step5031, it should be understood that any of the preliminary and latersteps described above in connection with other implementations and/ormethods and/or methods 4000, 4100, and 4200 may be performed in method5000 as well. For example, one or more other steps of any of the otherimplementations described herein such as for example, steps 4005-4035 ofthe method depicted in FIG. 40, steps 4105-4115 of the method depictedin FIG. 41, and steps 4205-4240 of the method depicted in FIG. 42 mayalso be included in the method depicted in FIG. 50.

Step 5031 may comprise using additional instrumentation to put forceupon and/or pull and/or stretch and/or make taught the scar tissueand/or fibrous tissue and/or the surrounding tissue(s). Step 5031 may beperformed using, for example, needles, sutures, hooks, clamps,retractors, probes, bars, endoscopes, rakes, tubes, TD and/or by hand.In some implementations step 5031 may be performed concurrently withstep 5032. Step 5032 may comprise passing the TD to at leastsubstantially free the scar tissue and/or other fibrous tissue from thesurrounding tissues. In some implementations, step 5032 may furthercomprise applying energy to the lysing member during this TD passage.Step 5033 may comprise identifying and/or testing the scar tissue and/orother fibrous tissue to determine if it has been sufficiently freed fromthe surrounding tissues and/or organ for uncomplicated removal. In someimplementations endoscopes and/or blunt probes and/or TD and/orsurgeon's hands may be passed around the scar tissue and/or otherfibrous tissue to test the degree of freedom the scar tissue and/orother fibrous tissue has from the surrounding tissues and/or organs (inorder to attempt hemostasis and/or modulate postoperative fibrosis).Step 5034 may comprise (if further freeing appears necessary) usingadditional instrumentation to put force upon and/or pull and/or stretchand/or make taught the scar tissue and/or other fibrous tissue and/orthe surrounding tissue and/or organ while the TD may be passed tofurther free the target scar tissue and/or other fibrous tissue; energymay be applied to the lysing member during this TD passage. Step 5034may be repeated as necessary until the target scar tissue and/or otherfibrous tissue is sufficiently freed and/or removed. Step 5035 maycomprise passing the TD (after the target scar tissue and/or fibrosishas been removed) to the tissues that were adjacent to the removedtissues (and still remaining in the body), which may aid the surgeon inexamining for points of further bleeding and/or for further exploration;during such TD passage, energy may be applied to the tissues via thelysing member(s) and/or the energy window(s). Step 5036 may compriseusing the TD to subdivide portions of the scar tissue and/or otherfibrous tissue which may aid in extracting the scar tissue and/or otherfibrous tissue in pieces if the surgery is done via a minimally invasivetechnique. In some implementations, if the surgical incision in the bodyis larger, the scar tissue and/or other fibrous tissue may pass morefreely out of the body without piecemeal removal. In someimplementations, one or more of these steps using the TD may beperformed with a fanning motion. In implementations using TD's withaxially oriented protrusions, such a fanning motion may comprise a toand fro spokewheel pattern. In implementations using TD's with at leastone nonaxially oriented protrusion, such a fanning motion may comprise aside-to-side fanning motion; one example of a fanning motion using a TDhaving at least one nonaxially oriented protrusion may comprise a‘windshield wiper’ motion. In some implementations, organs and/or organsystems that the TD may be useful to free and/or remove scar tissueand/or other fibrous tissue from may include but not limited to muscle,and/or parotid, and/or salivary gland, and/or thyroid, and/or lung,and/or heart (pericardial adhesions), and/or gastrointestinal(strictures), and/or liver, and/or pancreas, and/or spleen, and/orgallbladder (adhesions), and/or kidney, and/or adrenal, and/or prostate,and/or ovary, and/or uterus, and/or bladder, and/or vascular, and/orlymph nodes and/or skeleton, and/or central nervous system, and/orperipheral nervous system and/or lung (pleural adhesions) and/or fat(fibrous bands of cellulite). In some implementations, scarred and/orother fibrous tissue may bleed more than normal tissues when acted uponby a standard scalpel and/or surgical scissors; the TD may aid in suchscarred and/or fibrotic tissue removal as the TD may be able tocoagulate synchronously with both blunt and sharp dissectioncapabilities. The TD lysing member(s) may be able to contact more smallbleeding vessels (than a non-planar surgical device) due to TD's planargeometry and the chance that the geometry of the bleeding tissues may besubstantially planar.

An implementation of a method 5100 for incapacitating apocrine glands isshown in FIG. 51. Although method 5100 is shown in the figure beginningwith step 5105, it should be understood that any of the preliminary andlater steps described above in connection with other implementationsand/or methods and/or methods 4000, 4100, and 4200 may be performed inmethod 5100 as well. For example, one or more other steps of any of theother implementations described herein such as for example, steps4005-4035 of the method depicted in FIG. 40, steps 4105-4115 of themethod depicted in FIG. 41, and steps 4205-4240 of the method depictedin FIG. 42 may also be included in the method depicted in FIG. 51.

Step 5105 may comprise: having the surgical area cleaned by, forexample, isopropyl alcohol (degreaser) followed by germicidalchlorhexidine scrub. Step 5110 may comprise: applying a local anesthetic(such as injecting), such as about 1 cc of a 1% lidocaine+1:10,000adrenaline, to form about a wheal/hive on the periphery of the proposeddissection area on the axilla. Step 5115 may comprise, after allowingthe local anesthetic to settle, making an entrance incision and creatinga tip deployment pocket. The first sub-step of step 5115 may comprise,after allowing the local anesthetic to settle, performing a simple“stab” incision of the wheal, for example, a #15 Bard-Parker™ Scalpelinto the subcutaneous fat. This incision may be about 3 mm in length orless. The second sub-step of step 5115 may comprise creating a tipdeployment pocket that may receive the lysing tip; said pocket may bemade using a scalpel, scissors and/or wide array of instruments known inthe art to dissect tissue. The tip deployment pocket may be made byblunt dissection such as using a Metzenbaum scissors in a spreadingfashion and/or by sharp dissection using scalpel blade and/or scissorand/or energized dissection (for example, by laser and/orelectrosurgical needle and/or ultrasonic probe); bleeding points may becoagulated in the standard methods. In certain implementations, acomfortable size of the tip deployment pocket may be about 150% of thelength of the lysing tip with a comfortable range of 100% to 300% oflength of the lysing tip. For example, a 13 mm lysing tip may deploy tothe treatment configuration in a pocket of 2 cm squared or a circularpocket of 2 cm in diameter. In alternative implementations, the surgeonmay open an additional incision down the path closer to the treatmentzone.

Step 5120 may comprise: applying one or more fluids to the tissue. Insome implementations, the fluid(s) may comprise water. In someimplementations, the fluid(s) may comprise an ionic fluid, such as asaline solution. The fluid(s) may be applied to the tissue by, forexample, injection into the stab wound(s) and may comprise a fluid thatis both ionic and an anesthetic, such as a tumescent anesthesia. Someimplementations may comprise applying one or more fluids that serve asan ionic fluid, an anesthetic, and an adrenaline In some suchimplementations, the fluid(s) may comprise a Klein Formula, such asabout 1 cc-3 cc of Klein Formula (such as a 0.1% lidocaine+epinephrine1:1,000,000+NaHCO3 @5 meq/L of saline) per square centimeter ofanticipated dissection. This fluid(s) may be injected into the stabwounds via, for example, a 3 mm spatula cannula with syringe, and may befanned out to match the area to be dissected/undermined. In someimplementations, Tumescent Anesthesia (TA) may be allowed to settle forabout 10-30 minutes.

One or more fluids may alternatively, or additionally, be applied to thetissue by using the TD. For example, the TD may comprise one or morecanals for delivering fluids to the tissue (for example, canal 304depicted in FIG. 3a ). In some embodiments, the canal(s) may beconfigured to deliver the fluid(s) adjacent to the lysing tip such asvia a port located adjacent to the internal device cannula and/or lysingtip. In some such embodiments, the canal(s) may be configured to deliverthe fluid(s) to the area around the lysing tip.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated as described in theprevious method 5100 for apocrine glands.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated by a applying acooling step antecedent and or concurrent to energy delivery with theTD. Such steps may comprise use of a cooling mechanism such as a coolingmechanism comprising a contact cooling object such as a cooling pad orbag. Such cooling mechanism may comprise for example, a closed water bagat a temperature of less than 37° C. In some implementations, the fluidor gel may range in temperature of between 1° C. to 20° C. In some suchimplementations, the fluid or gel may be about 15° C. Other coolingmechanisms may comprise a dynamic cooling system wherein a cool liquidand/or gel and/or gas is actively pumped into or though the contactcooling object. In other implementations, a thermoelectric or Peltiercooling mechanism may be applied to externally cool the skin. One ormore cooling fluids (which may include gasses and/or gels) mayalternatively, or additionally, be applied to the tissue by using theTD. For example, the TD may comprise one or more canals for deliveringfluids such as coolants to the tissue. In some embodiments, the canal(s)may be configured to deliver the fluid(s) adjacent to the lysing tipsuch as via a port located adjacent to the internal device cannulaand/or lysing tip.

Step 5130 may comprise: inserting TD into the incision and fanning instrokes sufficient to cover a target area of for example, about 60 sqcm.

Step 5135 may comprise applying energy to one or more portions of thedissected area, for example, to heat the tissue to a desired temperatureto cause a desired effect, for example, to alter sweat glands and/ornerves and/or the tissues surrounding said glands or nerves. In someimplementations, such energy may be applied through the lysing tip byactivating the electrosurgical generator's coagulation mode. Inalternative embodiments, the lysing tip may be replaced with a tissuemodifying tip (TMT) illustrated in FIGS. 32 and 33 which may beactivated with coagulation energy. In alternative implementations, asurgeon may choose another method to apply energy to tissues. Applyingcooling fluids and/or cooling methods during this step may bebeneficial.

Step 5137 may comprise: milking the dissected area to determine if anysignificant bleeding or drainage is present.

Step 5140 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

TD may be used in an implementation of a method 5200 for incapacitatingeccrine glands as shown in FIG. 52. Although method 5200 is shown in thefigure beginning with step 5205, it should be understood that any of thepreliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 5200 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40, steps4105-4115 of the method depicted in FIG. 41, and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 52.

Step 5205 may comprise: having the surgical area cleaned by, forexample, isopropyl alcohol (degreaser) followed by germicidalchlorhexidine scrub. Step 5210 may comprise: applying a local anesthetic(such as injecting), such as about 1 cc of a 1% lidocaine+1:10,000adrenaline, to form a wheal/hive on the periphery of the proposeddissection area on the axilla. Step 5215 may comprise, after allowingthe local anesthetic to settle, making an entrance incision and creatinga tip deployment pocket. The first sub-step of step 5215 may comprise,after allowing the local anesthetic to settle, performing a simple“stab” incision of the wheal, for example, a #15 Bard-Parker™ Scalpelinto the subcutaneous fat. This incision may be about 3 mm in length orless. The second sub-step of step 5215 may comprise creating a tipdeployment pocket that may receive the lysing tip; said pocket may bemade using a scalpel, scissors and/or wide array of instruments known inthe art to dissect tissue. The tip deployment pocket may be made byblunt dissection such as using a Metzenbaum scissors in a spreadingfashion and/or by sharp dissection using scalpel blade and/or scissorand/or energized dissection (for example, by laser and/orelectrosurgical needle and/or ultrasonic probe); bleeding points may becoagulated in the standard methods. In certain implementations, acomfortable size of the tip deployment pocket may be about 150% of thelength of the lysing tip with a comfortable range of 100% to 300% oflength of the lysing tip. For example, a 13 mm lysing tip may deploy tothe treatment configuration in a pocket of 2 cm squared or a circularpocket of 2 cm in diameter.

Step 5220 may comprise: applying one or more fluids to the tissue. Insome implementations, the fluid(s) may comprise water. In someimplementations, the fluid(s) may comprise an ionic fluid, such as asaline solution. The fluid(s) may be applied to the tissue by, forexample, injection into the stab wound(s) and may comprise a fluid thatis both ionic and an anesthetic, such as a tumescent anesthesia. Someimplementations may comprise applying one or more fluids that serve asan ionic fluid, an anesthetic, and an adrenaline In some suchimplementations, the fluid(s) may comprise a Klein Formula, such asabout 1 cc-3 cc of Klein Formula (such as a 0.1% lidocaine+epinephrine1:1,000,000+NaHCO3 @5 meq/L of saline) per square centimeter ofanticipated dissection. This fluid(s) may be injected into the stabwounds via, for example, a 3 mm spatula cannula with syringe, and may befanned out to match the area to be dissected/undermined. In someimplementations, Tumescent Anesthesia (TA) may be allowed to settle forabout 10-30 minutes.

One or more fluids may alternatively, or additionally, be applied to thetissue by using syringes and/or other cannulas and/or tubing.Alternatively, the TD may comprise one or more canals for deliveringfluids to the tissue. In some embodiments, the canal(s) may beconfigured to deliver the fluid(s) adjacent to the lysing tip such asvia a port located adjacent to the internal device cannula and/or lysingtip. In some such embodiments, the canal(s) may be configured to deliverthe fluid(s) to the area around the lysing tip.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated as described in theprevious method 5000 for apocrine glands.

Step 5230 may comprise: inserting TD into the incision and fanning instrokes sufficient to cover a target area of for example, about 60 sqcm.

Step 5235 may comprise applying energy to one or more portions of thedissected area, for example, to heat the tissue to a desired temperatureto cause a desired effect, for example, to alter sweat glands and/ornerves and/or the tissues surrounding said glands or nerves. In someimplementations, such energy may be applied through the lysing tip byactivating the electrosurgical generator's coagulation mode. Inalternative embodiments, the lysing tip may be replaced with a tissuemodifying tip (TMT) illustrated in FIGS. 32 and 33 which may beactivated with coagulation energy. In alternative implementations, asurgeon may choose another method to apply energy to tissues. Applyingcooling fluids and/or cooling methods during this step may bebeneficial.

Step 5237 may comprise: milking the dissected area to determine if anysignificant bleeding or drainage is present.

Step 5240 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

TD may be used in one implementation of a method 5300 for incapacitatinghair follicles is shown in FIG. 53. Although method 5300 is shown in thefigure beginning with step 5305, it should be understood that any of thepreliminary and later steps described above in connection with otherimplementations and/or methods and/or methods 4000, 4100, and 4200 maybe performed in method 5300 as well. For example, one or more othersteps of any of the other implementations described herein such as forexample, steps 4005-4035 of the method depicted in FIG. 40, steps4105-4115 of the method depicted in FIG. 41, and steps 4205-4240 of themethod depicted in FIG. 42 may also be included in the method depictedin FIG. 53.

Step 5305 may comprise: having the surgical area cleaned by, forexample, isopropyl alcohol (degreaser) followed by germicidalchlorhexidine scrub. Step 5310 may comprise: applying a local anesthetic(such as injecting), such as about 1 cc of a 1% lidocaine+1:10,000adrenaline, to form about a wheal/hive on the periphery of the proposeddissection area.

Step 5315 may comprise, after allowing the local anesthetic to settle,making an entrance incision and creating a tip deployment pocket. Thefirst sub-step of step 5315 may comprise, after allowing the localanesthetic to settle, performing a simple “stab” incision of the wheal,for example, a #15 Bard-Parker™ Scalpel into the subcutaneous fat. Thisincision may be about 3 mm in length or less. The second sub-step ofstep 5315 may comprise creating a tip deployment pocket that may receivethe lysing tip; said pocket may be made using a scalpel, scissors and/orwide array of instruments known in the art to dissect tissue. The tipdeployment pocket may be made by blunt dissection such as using aMetzenbaum scissors in a spreading fashion and/or by sharp dissectionusing scalpel blade and/or scissor and/or energized dissection (forexample, by laser and/or electrosurgical needle and/or ultrasonicprobe); bleeding points may be coagulated in the standard methods. Incertain implementations, a comfortable size of the tip deployment pocketmay be about 150% of the length of the lysing tip with a comfortablerange of 100% to 300% of length of the lysing tip. For example, a 13 mmlysing tip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. In alternativeimplementations, the surgeon may open an additional incision down thepath closer to the treatment zone.

Step 5320 may comprise: applying one or more fluids to the tissue. Insome implementations, the fluid(s) may comprise water. In someimplementations, the fluid(s) may comprise an ionic fluid, such as asaline solution. The fluid(s) may be applied to the tissue by, forexample, injection into the stab wound(s) and may comprise a fluid thatis both ionic and an anesthetic, such as a tumescent anesthesia. Someimplementations may comprise applying one or more fluids that serve asan ionic fluid, an anesthetic, and an adrenaline In some suchimplementations, the fluid(s) may comprise a Klein Formula, such asabout 1 cc-3 cc of Klein Formula (such as a 0.1% lidocaine+epinephrine1:1,000,000+NaHCO3 @5 meq/L of saline) per square centimeter ofanticipated dissection. This fluid(s) may be injected into the stabwounds via, for example, a 3 mm spatula cannula with syringe, and may befanned out to match the area to be dissected/undermined. In someimplementations, Tumescent Anesthesia (TA) may be allowed to settle forabout 10-30 minutes.

One or more fluids may alternatively, or additionally, be applied to thetissue by using the TD. For example, the TD may comprise one or morecanals for delivering fluids to the tissue. In some embodiments, thecanal(s) may be configured to deliver the fluid(s) adjacent to thelysing tip such as via a port located adjacent to the internal devicecannula and/or lysing tip. In some such embodiments, the canal(s) may beconfigured to deliver the fluid(s) to the area around the lysing tip.Alternatively, or additionally, the fluid(s) may be delivered elsewhereon the tip or elsewhere on the shaft of the TD.

In some implementations, heat may be produced or energy may otherwise bereleased in the dermis or subdermis as the TD is passed in a subdermalplane. Heat or energy from below may heat the dermis. In someimplementations, heating portions of the dermis such as upper dermis orattached epidermis may be undesirable. As such, in some implementations,undesirable heating of such layers may be mitigated as described in theprevious method 5000 for apocrine glands.

Step 5330 may comprise: inserting TD into the incision and fanning instrokes sufficient to cover an area of for example, about 60 sqcm.

Step 5335 may comprise applying energy to one or more portions of thedissected area, for example, to heat the tissue to a desired temperatureto cause a desired effect, for example, to alter hair follicles and/orthe tissues surrounding said follicles. In some implementations, suchenergy may be applied through the lysing tip by activating theelectrosurgical generator's coagulation mode. In alternativeembodiments, the lysing tip may be replaced with a tissue modifying tip(TMT) illustrated in FIGS. 32 and 33 which may be activated withcoagulation energy. In alternative implementations, a surgeon may chooseanother method to apply energy to tissues. Applying cooling fluidsand/or cooling methods during this step may be beneficial.

Step 5337 may comprise: milking the dissected area to determine if anysignificant bleeding or drainage is present.

Step 5340 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

In one implementation, TD may be used for the treatment of cellulite,such as cellulite treatment zones 5401 and 5402 as shown in FIG. 54.Said implementation may comprise a method 5500 of steps listed in FIG.55. A more particular example of such an implementation is furtherillustrated in FIG. 54. It should be understood that any of the stepsdescribed above in connection with other implementations and/or methods4000, 4100, and 4200 may be performed in methods 5500 as well. Forexample, one or more other steps of any of the other implementationsdescribed herein such as for example, steps 4005-4035 of the methoddepicted in FIG. 40, steps 4105-4115 of the method depicted in FIG. 41,and steps 4205-4240 of the method depicted in FIG. 42 may also beincluded in the method depicted in FIG. 55.

Step 5505 comprises making an entrance incision. In some implementationsstep 5505 may comprises making a stab incision 5410 in a location thatis not usually visible to the eye, for example, the bikini line. In someimplementations the incision may be of sufficient length to receive thelysing tip and/or cannula in an axial/delivery configuration.Preferably, the length of the incision is no greater than as necessaryto receive the lysing tip and/or cannula. Preferably, the length of theincision is smaller than the length of the lysing tip in its treatmentconfiguration. In some implementations, the length of the incision maybe between about 2 mm and 12 mm.

Step 5510 may comprise forming a tip deployment pocket 5411 a forreceipt and/or reconfiguring of the lysing tip from its deliveryconfiguration to its treatment configuration. In some implementations,curved blunt scissors may be used to make this tip deployment pocket byfor example inserting said scissors up to its pivot point and/oropening/closing the scissors. In some implementations, the tipdeployment pocket may be approximately the size of half of a postagestamp. For example, the tip deployment pocket may have a width in thedirection of the incision of about 1 cm. Similarly, the tip deploymentpocket may have a length perpendicular to the width of between about 1cm to 2 cm. The dissection plane of the pocket is preferably in the sameplane of dissection of the path to the treatment zone and/or thetreatment zone. However, it is contemplated that in an alternativeimplementation a surgeon may use the TD to move from the plane of thepocket into another tissue plane. Preferably, the width of the tipdeployment pocket is larger than the length of the incision to, forexample, minimize scarring but create an area large enough toaccommodate the lysing tip being deployed to its treatmentconfiguration. Preferably, the width of the tip deployment pocket isapproximately equal to or slightly larger than the length of the lysingtip. In some implementations, the proximal edge of the tip deploymentpocket defining the width of the pocket may be coincident with orpositioned slightly distal of the incision line as shown in FIG. 54a .The tip deployment pocket may be made using a scalpel, scissors, and/orwide array of instruments known in the art to dissect tissue. In certainimplementations, a comfortable size of the tip deployment pocket may beabout 150% of the length of the lysing tip with a comfortable range of100% to 300% of length of the lysing tip. For example, a 13 mm lysingtip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. In alternativeimplementations, the surgeon may open an additional incision down thepath closer to the treatment zone.

Step 5515 may comprise inserting the TD through the incision anddeploying/securing the lysing tip. In some implementations, the TD maybe deployed through a cannula and once within the tip deployment pocketmay be reconfigured from its delivery configuration to its treatmentconfiguration. In other implementations, the lysing tip and/orgrasping/control means may be inserted through the incision to the tipdeployment pocket in which the lysing tip and grasping/control means maybe coupled together in the treatment configuration. For example, thelysing tip may be grasped in an axial configuration such as along one ofthe sides of the grasping pad 718 as shown in FIG. 7e . The lysing tipmay then be released and rotated manually, such as by palpation, afterwhich the lysing tip may be grasped in the treatment configuration withthe elongated length of the lysing tip perpendicular or at leastsubstantially perpendicular to the axis of the grasping/control. means.

In some implementations in which the lysing tip, either lysing tip 710or any of the other free floating lysing tips disclosed herein, aremanually inserted, a surgeon may insert the lysing tip through anentrance incision such that the longest axis of the lysing tip(typically the axis between the two outer protrusions and/or beads) isparallel or at least substantially parallel to the direction ofinsertion. Once the lysing tip has been inserted through the entranceincision, the lysing tip may be manually rotated such as by palpation,or by use of the control/grasping instrument, or an external device suchas a hemostat or another suitable instrument. In some suchimplementations, a tip deployment pocket may be created before insertionof the lysing tip as discussed below. This tip deployment pocket mayfacilitate rotation of the lysing tip and/or may allow for coupling ofthe lysing tip with a suitable instrument for delivering electrosurgicalenergy and/or controlling the lysing tip during a surgical procedure.

Step 5516 may comprise having in place and utilizing an infrared and/orheat detecting camera 13 (e.g., FLIR®) connected by wire or wirelessly(for example via antennae 47 a) to a central processing unit 14 andoutput video monitor 15; the camera data may be combined with data inputthat may be generated by signals originating from RFID chips and/orantennae 47 with further data that may originate from sensors 48 thatmay be located on or near lysing tips or TMTs (lysing tip and controlgrasping instrument system 16 are depicted in FIG. 54a with antennae 47and sensor 48 mounted on grasping control instrument shaft). In someembodiments, sensor 48 may be a thermistor. Infrared camera imagesoverlying sensor outputs and location outputs on the video screen mayaid the surgeon in determining the proper speed of the tip and/orsettings and/or dwelling time. One or more of these steps involving useof an infrared camera may be applied to other ski-related methodsdisclosed herein such as those related to treatment of apocrine andeccrine sweating, incapacitation of hair follicles, treatment ofcellulite, wrinkles, lines, folds, and other defects, as well asrejuvenational treatments for the face, neck, and brow/scalp.

Step 5520 may comprise forming one or more paths 5412 a/5412 b to one ormore treatment zones 5401 and/or 5402 respectively. In someimplementations, a fifth step may comprise activating one or more lysingmembers and then advancing the lysing tip towards the treatment zone.This may be done for example in a series of substeps by advancing thelysing tip and pulling it back in a repeated fashion similar to abattering ram. The surgeon may create additional paths adjacent to theinitial path, thus creating a triangular and/or cone shape between theincision and the treatment zone. In alternative implementations, whereinthe surgeon may prefer to minimize the amount of energy deposited alongthe path to the target tissue/cellulite treatment zone, especially whileusing lysing tips of 3 protrusions or less, the lysing tip may berotated with the lysing rod axis perpendicular to the plane of the skinto create the path. Rotating the lysing rod axis perpendicular may allowthe tip to migrate in between the vertically oriented fibrous bandsbetween the dermis and the lower/deeper tissues. As shown in FIG. 54a ,if the treatment zone 5401 has a width wider than the width of the path,the surgeon may, either right before or simultaneously with movement ofthe tip into the treatment zone, manipulate the treatment zone, such asby traction (either manual or using instrumentation), into the path ofthe lysing tip. For example, as indicated by arrow 5415, initially a topportion of the treatment zone may be forced downward into the path ofthe lysing tip. The lysing tip may then be used to treat the top portionof the treatment zone. Subsequently, a bottom portion of the treatmentzone may then be manipulated in the direction of arrow 5416 into thepath of the lysing tip and the lysing tip may then be used to treat thebottom portion of the treatment zone. In some implementations, thelysing tip will extend beyond the boundaries of the treatment zone 5401;this “feathering” beyond the boundaries into more normal tissues mayensure full treatment of the condition. This step may be repeated totreat all of the various treatment zones such as 5402. Preferably, pathsto each of the various treatment zones (for example, 5412 b) may comefrom the same incision 5410 and tip deployment pocket 5411.

In an alternative implementation depicted in FIG. 54b , the tipdeployment pocket 5411 b may be more adjacent to the treatment zone5401. In some such implementations the tip deployment pocket 5411 b maybe formed during the course of repositioning the lysing tip between itsdelivery and treatment configurations. For example, the proximal portionof the path 5413 may be formed by advancing the cannula and/or lysingtip from the incision in the delivery configuration after which thelysing members may be activated and the lysing tip rotated or otherwiserepositioned from the delivery to the treatment configurations therebyforming a tip delivery pocket for delivery of the lysing tip to thetreatment zone.

Step 5525 may comprise, after lysing the tissues in the treatment zone,applying energy to the treatment zone. In some implementations,energizing the lysing member(s) with a cut and/or coagulation and/orblend between cut and coagulation energy waveforms may accomplish adesired treatment, for example, heating/denaturing the subcutaneousadipose tissues which may result in their reduction and/or heating thesubdermal tissue layers to cause a skin tightening effect. In otherimplementations, to apply energy to the treatment zone(s), the lysingtip may be withdrawn from the incision and another energy depositiondevice and/or a TMT (Tissue Modification Tip) may be energized todeposit energy in the treatment zone(s) for an intended effect. The TMTmay be passed to or through the treatment zone with the energy windowfacing upwards towards the subdermal layers. Possible results ofpointing upwards may include alteration of the collagen in that areayielding overlying skin tightening. In some implementations, the TMT maybe turned upside down with the energy window directed at thesubcutaneous adipose tissue layer and energized during at least part ofthe procedure. Possible results of this may include the alterationand/or damaging and/or death of some adipose cells that stimulate aninflammatory response in the subcutaneous adipose tissues that maytransfer to the subdermal and/or dermal layers via cells and/orchemical/biological mediators thus possibly resulting in the alterationof tissue thickness and/or tissue tightening in tissues that had notbeen directly damaged/modified by the lysing tip and/or TMT.

In some implementations, a surgeon may reduce bleeding by use of suchinstruments as a bovie probe and/or grasper/clamp. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and fatmodification. In such implementations, the energy window of the TMT maybe configured to deliver the following types of energy modalitiesincluding but not limited to laser, intense pulse light, resistiveheating, radiant heat, thermochromic, ultrasound, and/or microwave.

Step 5530 may comprise rotating and/or reconfiguring the lysing tip backinto the delivery configuration in either the treatment area and/or thetip deployment pocket and/or the path, if it is sufficiently wide, andwithdrawing the lysing tip and/or cannula back through the incision.

An example of a method 5600 for face dissection and/or face liftingaccording to some implementations will now be described as illustratedin FIG. 56.

Step 5605 may comprise, after allowing the local anesthetic to settle,making and/or extending and/or using an existing entrance incision atthe front/bottom/rear of the ear and creating a tip deployment pocket.However, incisions with endoscopic and/or laparoscopic instrumentsshould not be limited to this area as cosmetic surgeons may prefer toplace incisions at anatomical boundaries and/or natural crease areas. Infurther contemplated embodiments, intra-oral, intra-nasal, and routes ofinstrument passage through the inner eyelids may be used for deviceand/or tip delivery. For example, an incision may be made where the noseand lip meet the cheek. An incision may be made in the skin in such aselected area so as to introduce a laparoscopic/endoscopic instrument,scissors, and/or scalpel to create a tip deployment pocket adjacent theincision if desired. The first sub-step of step 5605 may comprise, afterallowing the local anesthetic to settle, performing a simple “stab”incision of the wheal, for example, a #15 Bard-Parker™ Scalpel into thesubcutaneous fat. This incision may be about 3 mm in length or less. Thesecond sub-step of step 5605 may comprise creating a tip deploymentpocket that may receive the lysing tip which may be positioned at thedistal end of the device, which pocket may be made/enlarged with ascalpel, any laparoscopic instrument with or without electrosurgicalcurrent applied to it, an ultrasonic surgical device and/ormicrowave-powered instrument and/or laparoscopic scissors, and/orthermochromic media, electromagnetically energized instrument, and/orthermally energized instrument, and/or scissor tips, and/or knife tips.The tip deployment pocket may be made by blunt dissection such as usinga Metzenbaum scissors in a spreading fashion and/or by sharp dissectionusing scalpel blade and/or scissor and/or energized dissection (forexample, by laser and/or electrosurgical needle and/or ultrasonicprobe); bleeding points may be coagulated in the standard methods. Incertain implementations, a comfortable size of the tip deployment pocketmay be about 150% of the length of the lysing tip with a comfortablerange of 100% to 300% of length of the lysing tip. For example, a 13 mmlysing tip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. The tip deploymentpocket may or may not be the desired tissue layer of the dissectionand/or the final dissection as various blends of dissection planes maybe used by certain surgeons to achieve desired face lifting. However, acomfortable plane in which to create a tip deployment pocket wouldlikely be the upper subcutaneous plane in the preauricular region. Tipdeployment pockets may be created in other locations using endoscopicinstruments farther along the planned path of dissection and/or viaseparate stab incision further along the path of dissection. Theinstrument that made the tip deployment pocket is then removed.Depending upon the quality of the tissue in the tip deployment pocketadjacent the entrance incision, the lysing tip of the TD may be used toform the tip deployment pocket by energizing the lysing members of thelysing tip while rotating the lysing tip from the delivery configurationto the treatment configuration.

Step 5610 may comprise inserting the TD through the incision into thetip deployment pocket for receipt and/or reconfiguring of the lysing tipfrom its delivery configuration to its treatment configuration.

In some implementations, the TD may be deployed through a cannula andonce within the tip deployment pocket may be reconfigured from itsdelivery configuration to its treatment configuration. In otherimplementations, the lysing tip and/or grasping/control means may beinserted through the incision to the tip deployment pocket in which thelysing tip and grasping/control means may be coupled together in thetreatment configuration. For example, the lysing tip may be grasped inan axial configuration such as along one of the sides of the graspingpad 718 as shown in FIG. 7e prior to inserting the TD in the incision.The lysing tip may then be inserted in the incision and released. Thenthe lysing tip may be rotated; if necessary, manual rotation may beimplemented (for example, by palpation) after which the lysing tip maybe grasped in the treatment configuration with the elongated length ofthe lysing tip perpendicular or at least substantially perpendicular tothe axis of the grasping/control means.

Step 5615 may comprise making paths with the TD. In someimplementations, after activating the TD, the surgeon may advance thetip a certain distance, for example, 2 cm. The tip may then be pulledback (with or without electrosurgical energy), in some cases to the tipdeployment pocket, and dissection may then proceed along the same pathor along an immediately adjacent path. It may be convenient for thesurgeon to only partially overlap advancing strokes especially in moredense tissue. It may also be beneficial not to use energy on thewithdrawal (non-forward) portion of the strokes. A possible example ofonly partially overlapping advancing strokes is, if the device is fourbulbs wide (the initial path should be about four bulbs wide); a newadjacent path may be lysed with two bulbs in the new adjacent path andtwo bulbs in the previously dissected path. The device tip may then bepulled back, in some cases to the tip deployment pocket, and advanced onthe other adjacent path immediately adjacent to the original dissectionpath with two bulbs in the new adjacent path and two bulbs in theoriginal dissection path. If using the four bulb device example, thewidth of the original dissection would be four bulbs. Then theadditional adjacent dissection paths would be two plus two bulbs inwidth resulting in an overall two plus two plus two equal six bulb widthpath after three forward strokes. The device path may be lengthened insegments in a similar fashion. The device path width may be increased insegments in a similar fashion.

The dissection may be increased segmentally until it occupies the entirearea the surgeon desires to dissect at the appropriate depth or plane(s)of choice of the surgeon. Other endoscopic instruments may be used toobserve and/or maintain the plane and/or address bleeding blood vesselsand/or tissues. Upon completion of the desired dissection, within anypoint of the dissection with sufficient area, the lysing tip may berotated from the treatment configuration to the delivery configurationand withdrawn through the entrance incision.

Step 5620 may comprise subjecting some or all exposed tissue(s) toadditional energy via a lysing tip or a separate TMT. In someimplementations, after dissection in segments and/or the totaldissection, one or more additional types of energy may be applied to theinner and/or outer layers of the dissection plane. The lysing member ofthe TD and/or the energy window of the TMT may be directed at thesubcutaneous adipose tissue layer and energized. Possible results ofthis may include the alteration and/or damaging and/or death of someadipose cells that stimulate an inflammatory response in thesubcutaneous adipose tissues that may transfer to the subdermal and/ordermal layers via cells and/or chemical/biological mediators thuspossibly resulting in the alternation of tissue thickness and/or tissuetightening in tissues that had not been directly damaged/modified by thelysing tip and/or TMT. In other implementations, energy applied to theinner layer of the dissection plane may alter and/or damage othertissues including fibrous tissues wherein the results of damaging saidtissues may release mediators and/or products of damage such as charreddebris which may also stimulate an inflammatory and/or immunologicresponse that may cause tissue contraction and/or fibrosis in that layerof the dissection plane and/or in an adjacent layer. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and fatmodification.

In some implementations, a surgeon may reduce bleeding by use of suchinstruments as a bovie probe and/or graspers or clamps and/or graspingand/or clamp-like instruments. In some implementations, a deviceutilizing ultrasonic vibration to cut and cauterize tissue such as aharmonic scalpel may be used to reduce bleeding. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and/orfatty tissue modification. In such implementations, the energy window ofthe TMT may be configured to deliver the following types of energy:electrosurgical, ultrasound, intense pulse light, laser, radiant heat,thermochromic, and/or microwave. In such implementations, the energywindow of the TMT may be configured to deliver the following types ofenergy modalities including, but not limited to, laser, intense pulselight, resistive heating, radiant heat, thermochromic, ultrasound,mechanical, and/or microwave.

Step 5623 may comprise: lightly milking the dissected area to determineif any significant bleeding or drainage is present.

Step 5624 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

Step 5625 may comprise post-operative care. Some post-operativedressings may be appropriate to reduce the incidence of seromas and/orhematomas. Appropriate dressings may include some with pressurecharacteristics. Incisions may be dealt with by methods that may includesuturing and/or stapling and/or tissue gluing and/or taping, forexample, with Steri-strips® and/or other methods that the surgeon maydesire.

An example of a method 5700 for neck dissection and/or neck liftingaccording to some implementations will now be described as illustratedin FIG. 57. This method may be performed by itself or with otherprocedures including method 5600.

Step 5705 may comprise, after allowing the local anesthetic to settle,making and/or extending and/or using an existing entrance incision andcreating a tip deployment pocket. In some implementations, the neckdissection may be carried out by extending the lower portion of the facelift dissection or separately as its own procedure. Therefore, neckdissection entrance wounds may be located in the submental crease areaand/or around the chin. Other entrance areas may also include thosearound the ear. However, incisions with endoscopic and/or laparoscopicinstruments should not be limited to this area as cosmetic surgeons mayprefer to place incisions at anatomical boundaries and/or natural creaseareas. The first sub-step of step 5705 may comprise, after allowing thelocal anesthetic to settle, performing a simple “stab” incision of thewheal, for example, a #15 Bard-Parker™ Scalpel into the subcutaneousfat. This incision may be about 3 mm in length or less. The secondsub-step of step 5705 may comprise creating a tip deployment pocket thatmay receive the lysing tip at the distal end of the device; the tipdeployment pocket may be made using a scalpel, scissors, and/or widearray of instruments known in the art to dissect tissue. The tipdeployment pocket may be made by blunt dissection such as using aMetzenbaum scissors in a spreading fashion and/or by sharp dissectionusing scalpel blade and/or scissor and/or energized dissection (forexample, by laser and/or electrosurgical needle and/or ultrasonicprobe); bleeding points may be coagulated in the standard methods. Incertain implementations, a comfortable size of the tip deployment pocketmay be about 150% of the length of the lysing tip with a comfortablerange of 100% to 300% of length of the lysing tip. For example, a 13 mmlysing tip may deploy to the treatment configuration in a pocket of 2 cmsquared or a circular pocket of 2 cm in diameter. The tip deploymentpocket may or may not be the desired tissue layer of the dissectionand/or the final dissection as various blends of dissection planes maybe used by certain surgeons to achieve desired neck lifting. However, acomfortable plane in which to create a tip deployment pocket may be theupper subcutaneous plane in the preauricular region. Tip deploymentpockets may be created in other locations using laparoscopic/endoscopicinstruments farther along the planned path of dissection and/or viaseparate stab incision further along the path of dissection. Theinstrument that made the tip deployment pocket may then be removed.Depending upon the quality of the tissue in the tip deployment pocketadjacent the entrance incision, the lysing tip of the TD may be used toform the tip deployment pocket by energizing the lysing members of thelysing tip while rotating the lysing tip from the delivery configurationto the treatment configuration.

Step 5710 may comprise forming a tip deployment pocket for receiptand/or reconfiguring of the lysing tip from its delivery configurationto its treatment

Step 5715 may comprise making paths with the TD. In someimplementations, after activating the TD, the surgeon may advance thetip a certain distance, for example, 2 cm. The tip may then be pulledback (with or without electrosurgical energy), in some cases to the tipdeployment pocket, and dissection may then proceed along the same pathor along an immediately adjacent path. It may be beneficial to reducethe amount of potential tissue damaging energy to use energy onadvancing strokes of the TD and not using energy on the withdrawal(non-forward) portion of the strokes. For example, if the device is fourbulbs wide, that is the width of the initial path. The new adjacent pathmay be lysed with two bulbs in the new adjacent path and two bulbs inthe previously dissected path. The device tip may then be pulled back,in some cases to the tip deployment pocket, and advanced on the otheradjacent path immediately adjacent to the original dissection path withtwo bulbs in the new adjacent path and two bulbs in the originaldissection path. If using the four bulb device example, the width of theoriginal dissection would be four bulbs. Then the additional adjacentdissection paths would be two plus two bulbs in width resulting in anoverall two plus two plus two equal six bulb width path after threeforward strokes. The device path may be lengthened in segments in asimilar fashion. The device path width may be increased in segments in asimilar fashion.

The dissection may be increased segmentally until it occupies the entirearea the surgeon desires to dissect at the appropriate depth or plane(s)of choice of the surgeon. Other endoscopic instruments may be used toobserve and/or maintain the plane and/or address bleeding blood vesselsand/or tissues. Upon completion of the desired dissection, within anypoint of the dissection with sufficient area, the lysing tip may berotated from the treatment configuration to the delivery configurationand withdrawn through the entrance incision.

Step 5620 may comprise subjecting some or all exposed tissue(s) toadditional energy via a lysing tip and/or a separate TMT. In someimplementations, after dissection in segments and/or the totaldissection, one or more additional types of energy may be applied to theinner and/or outer layers of the dissection plane. The lysing member ofthe TD and/or the energy window of the TMT may be directed at thesubcutaneous adipose tissue layer and energized. Possible results ofthis may include the alteration and/or damaging and/or death of someadipose cells that stimulate an inflammatory response in thesubcutaneous adipose tissues that may transfer to the subdermal and/ordermal layers via cells and/or chemical/biological mediators thuspossibly resulting in the alternation of tissue thickness and/or tissuetightening in tissues that had not been directly damaged/modified by thelysing tip and/or TMT. In other implementations, energy applied to theinner layer of the dissection plane may alter and/or damage othertissues including fibrous tissues wherein the results of damaging saidtissues may release mediators and/or products of damage such as charreddebris which may also stimulate an inflammatory and/or immunologicresponse that may cause tissue contraction/tightening and/or fibrosis inthat layer of the dissection plane and/or in an adjacent layer.

Step 5623 may comprise lightly milking the dissected area to determineif any significant bleeding or drainage is present.

Step 5624 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

Step 5625 may comprise, after the neck has been dissected, addressingsuch other concerns as platysmal banding and/or prolapsed tissues suchas salivary glands using sutures and/or meshes and/or otherlaparoscopic/endoscopic tools as known in the art. In someimplementations, a surgeon may reduce bleeding by use of suchinstruments as a bovie probe and/or graspers or clamps and/or graspingand/or clamp-like instruments. In some implementations, a deviceutilizing ultrasonic vibration to cut and cauterize tissue such as aharmonic scalpel may be used to reduce bleeding. In alternativeimplementations, the surgeon may use the lysing members of the lysingtip and/or the energy window of the TMT to modify tissues for variousintended results, including but not limited to skin tightening and/orfatty tissue modification. In such implementations, the energy window ofthe TMT may be configured to deliver the following types of energy:electrosurgical, ultrasound, intense pulse light, laser, radiant heat,thermochromic, and/or microwave.

Step 5630 may comprise post-operative care. Some post-operativedressings may be appropriate to reduce the incidence of seromas and/orhematomas. Appropriate dressings may include some with pressurecharacteristics. Incisions may be dealt with by methods that may includesuturing and/or stapling and/or tissue gluing and/or taping, forexample, with Steri-strips® and/or other methods that the surgeon maydesire.

The TD may be used to treat various skin wrinkles, lines, folds andother visible defects. In an implementation, dissecting with the TDthrough, or around the platysma muscle in the neck in areas of lines orwrinkles may alter the attachments of the platysma to overlying oradjacent skin and thus diminish the visible assessment of surfacedefects.

In an alternative implementation, dissecting and/or energizing with theTD through or around the muscles of facial expression located in thesuperior nose, glabellar region, and/or adjacent tissues, for example,the procerus muscle, depressor supercilii muscle, and corrugatorsupercilii muscle may damage, denature, fibrose, alter, denervate and/ordisconnect the muscles and their action from the overlying or adjacentskin thus reducing the frown wrinkles or folds around the superior nose.

In some implementations, the surface skin effects of other muscles offacial expression may be altered by dissecting the tissues which may beattached between those muscles and the surface skin, no matter howloosely or indirect, using the TD. For example, some muscles of facialexpression around the mouth contribute to the formation of the nasallabial fold which gives may give an aging appearance depending upon itsdepth, acuteness, and/or shadow effect. Disinserting the surface skin inthe area from the underlying or adjacent tissues by dissecting with theTD may diminish the visibility of these folds. The entrance incision forthe TD to approach or reach the nasal labial fold may be anywhere on theface or head as well as inside the mouth or nose.

In another implementation, dissection with the TD may be used todiminish forehead wrinkles wherein the dissection and/or energy maydamage, denature, fibrose, alter, denervate and/or disconnect themuscles and their action from the overlying or adjacent skin thusreducing the brow and/or forehead wrinkling.

In another implementation, the wrinkles around the lower and outereyelids may be altered by dissecting between the orbicularis oculimuscle and the skin wherein a sheet of fibrous tissue may be laid downfollowing dissection and/or energy which may have a less foldablecharacter than the previously soft and pliable tissues. The entranceincision for the TD to approach the eyelid may be inside the lowereyelid through the conjunctiva and/or in a wrinkle of the face or lowereyelid.

Steps: everything for creating a path except can enter from inside noseor mouth or eye for areas mentioned above. Likely 2 bulb unit used.Since wrinkle or fold, dissection will be along the length of or aroundthe fold, not perpendicular to it. May be with or without energy. Mayuse TMT after dissection is complete; may point up or down. May be usedin conjunction with an implant, even an injectable, solid, semi-solidimplant. Finally, withdraw and sew.

An example of a method 5800 for brow and/or scalp dissection and/or browlifting according to some implementations will now be described asillustrated in FIG. 58. Step S805 may comprise making a sufficientnumber of incisions at the back of neck near or at the hairline and/orforehead/frontal hairline that permits sufficient passage of TD forintended effect. In other implementations, incisions may be madeanywhere within the scalp region. Step 5810 may comprise creating thetip deployment pocket as disclosed herein. Step 5810 may compriseforming a tip deployment pocket for receipt and/or reconfiguring of thelysing tip from its delivery configuration to its treatment. Step 5815may comprise dissecting the subgaleal plane with TD and may comprisefanning in the subgaleal plane, for example, in a spokewheel pattern, tothe extent desired by the surgeon. Step 5820 may comprise reconfiguringthe TD from the treatment configuration to the delivery configurationand/or removal through the entrance incision. Step 5825 may comprise,after desired tissue plane separation, rotating the dissected scalp into the desired position, for example, backward toward neck. Step 5830may comprise applying a fixation mechanism, for example, screws.

An example of a method 5900 for creation of pockets for implants,including, but not limited to, cosmetic implants, medical device andidentification implants is described. An implant may be defined hereinas any material surgically deposited and left in a patient/recipient'sbody that was not manufactured by the recipient's body. The TD may beuseful because it may expeditiously create said paths and said pocketswith minimal bleeding. Examples of cosmetic implant procedures in whichthe TD may be used may include, but are not limited to, skin, breast,face (cheek, brow), muscle (biceps, triceps, calf), and buttocksimplants, to name a few. Examples of medical device implants in whichthe TD may be used may include, but are not limited to, drug implantdevices, for example, insulin infusion pumps, cardiac pacemakers,artificial joints, implantable neurologic devices, implantable trackingand/or identification (for example, RFID) chips, to name a few. Theplacement of many implants, to minimize visible scarring, may involvecreating one or more paths to the implant zone. Method 5900 according tosome implementations will now be described as illustrated in FIG. 59.The implementations and embodiments from FIGS. 54 and 55 involving thetreatment of cellulite are incorporated herein and may be modified asfollows.

Implementation 5900 to place a cosmetic implant may use same route(s) asfor cellulite treatment, however, the tip may be deployed to itstreatment configuration closer to implant zone. The width of the pathand the entrance incision is preferably the minimum size needed for theimplant to traverse the path from the opening incision to the implantpocket. In some implementations, the surgeon may have to open up anadditional incision to place implant; this may depend upon whether theimplant has a capsule or has gel that will be moved to through the pathto the pocket. The surgeon may create a pocket appropriately sized forthe implant to rest.

Step 5905 comprises making an entrance incision. In someimplementations, step 5905 may comprises making a stab incision in alocation that is not usually visible to the eye from a reasonabledistance, for example, the umbilicus/bellybutton and/or under the axillaand/or around the nipple in the case of a breast implant. The width ofthe entrance incision is preferably the minimum size needed for the TDtip and shaft to traverse the entrance incision. Although the implantmay be of a larger diameter, it may be preferable for optimizingtraction keep the entrance incision its minimum size until the path tothe implant zone and/or the implant pocket are created.

Step 5910 may comprise forming a tip deployment pocket similar to thatdepicted in 5411 a at FIG. 54 for receipt and/or reconfiguring of thelysing tip from its delivery configuration to its treatmentconfiguration. In some implementations, curved blunt scissors may beused to make this tip deployment pocket by for example inserting saidscissors up to its pivot point and/or opening/closing the scissors. Insome implementations, the tip deployment pocket may be approximately thesize of half of a postage stamp. For example, the tip deployment pocketmay have a width in the direction of the incision of about 1 cm.Similarly, the tip deployment pocket may have a length perpendicular tothe width of between about 1 cm to 2 cm. In some implementations, thesurgeon may desire to open an additional incision to place the implant;this may depend upon whether the implant has a capsule or has gel thatwill be moved to through the path to the pocket.

Step 5915 may comprise reconfiguring the lysing tip within the tipdeployment pocket for receipt and/or reconfiguring of the lysing tipfrom its delivery configuration to its treatment In someimplementations, a surgeon may make such a wide entrance incision thatthe lysing tip may even fit through the incision in the treatmentconfiguration. In some implementations, the TD may be deployed through acannula and once within the tip deployment pocket may be reconfiguredfrom its delivery configuration to its treatment configuration. In otherimplementations, the lysing tip and/or grasping/control means may beinserted through the incision to the tip deployment pocket in which thelysing tip and grasping/control means may be coupled together in thetreatment configuration.

Step 5920 may comprise forming one or more paths to one or more implantzones as depicted in FIG. 54a . In some implementations, this maycomprise activating one or more lysing members and then advancing thelysing tip towards the implant zone. This may be done for example in aseries of substeps by advancing the lysing tip and pulling it back in arepeated fashion. The surgeon may create additional paths adjacent tothe initial path, thus creating a triangular and/or cone shape betweenthe incision and the implant zone. As shown in FIG. 54a , if thetreatment zone 5402 has a width wider than the width of the path, thesurgeon may, either right before or simultaneously with movement of thetip into the treatment zone, manipulate the treatment zone, such as bytraction (either manual or using instrumentation), into the path of thelysing tip. The width of the path may be the minimum dimensions neededfor the implant to traverse the path.

Step 5921 may comprise the surgeon creating an implant pocketappropriately sized for the implant to rest.

Step 5922, perhaps after removal of the TD, may comprise expanding theentrance incision to the minimum dimensions required for the maximumdimension of the implant to traverse the entrance incision.

Step 5925 may comprise, after lysing the tissues, applying energy to theimplant zone with the TD or a separate TMT. In some implementations, asurgeon may reduce bleeding by use of such instruments as a bovie probeand/or grasper/clamp. In alternative implementations, the surgeon mayuse the lysing members of the lysing tip and/or the energy window of theTMT to modify tissues for various intended results, including but notlimited to skin tightening and fat modification. In suchimplementations, the energy window of the TMT may be configured todeliver the following types of energy modalities including but notlimited to laser, intense pulse light, resistive heating, radiant heat,thermochromic, ultrasound, and/or microwave.

Step 5930 may comprise rotating and/or reconfiguring the lysing tip backinto the delivery configuration in either the treatment area and/or thetip deployment pocket and/or the path, if it is sufficiently wide, andwithdrawing the lysing tip and/or cannula back through the incision.

Step 5935 may comprise delivery and/or placement and/or securing of theimplant according to manufacturers' recommendations and/orspecifications and/or qualified surgeons' modifications. Securing of theimplant may include, but not be limited to, placing sutures, staples,and/or retention devices either in the tissues around the implant and/oralong the tissues along the path of the implant and/or the tissues alongthe entrance incision.

Step 5940 may comprise closing the entrance wounds or surface incisionsvia glues, staples, adhesive skin closure strips, and/or sutures.

An example of a method 6000 for a capsulotomy and/or a capsulectomy willnow be described as illustrated in FIG. 60. As breast implants may beviewed by the human body as a foreign object, scar tissue may developaround a breast implant over a 3 to 4 year period. This capsule ofscar/fibrous tissue may be of a spherical shape. Step 6005 may comprisemaking an entrance incision as previously described herein. Step 6010may comprise creating a tip deployment pocket near to or away from theentrance incision as previously described herein. Step 6015 may compriseinserting the TD in its delivery configuration and re-configuring the TDto its treatment configuration as previously described herein. Step 6020may comprise activating the TD and creating paths to the treatment zone,in this embodiment, around the capsule. Step 6025 may compriseactivating the TD and lysing the adhesions attaching to the capsule tothe implant and/or surrounding tissues by moving along the periphery ofcapsule. Step 6028 may comprise returning the lysing tip to a deploymentconfiguration. Step 6030 may comprise removal of the TD as previouslydescribed herein. Step 6035 may comprise separation and/or removal of atleast a portion of the capsule from the surrounding tissues and/or theimplant. In some implementations, step 6035 may be performed before step6030.

Step 6035 may comprise withdrawal of the lysing tip. Step 6040 maycomprise closing the entrance wounds or surface incisions via glues,staples, adhesive skin closure strips, and/or sutures.

An example of a method 6100 for body lifting and skin excision will nowbe described as illustrated in FIG. 61. An example of a use of thismethod includes tightening of sagging tissue on arms. Generally, thisprocedure involves undermining skin, excising a portion of said skin,and pulling tight the remaining skin.

Step 6105 may comprise making the skin incision near the underminingzone as previously described herein which may be under the arm pit andhydrating/tumescent the area to be undermined as stated previously. Thearea to be undermined may be 10 to 20 cm beyond the location of theincision demarking the skin to be removed. Step 6110 may comprisewidening the entrance incision and creating the tip deployment pocket asstated previously. Step 6115 may comprise inserting the lysing tip inits delivery configuration into the tip deployment pocket and deployingthe lysing tip to the treatment configuration.

Step 6120 may comprise undermining/lysing skin in locations beneath theskin to be removed as well as locations adjacent thereto in order tohave sufficient tissue to pull the edges of the remaining tissuetogether to be closed. In this step, fat may be heated/removed as well.Step 6125 may comprise withdrawal of the lysing tip.

Step 6130 may comprise making the incision, which may be in the form ofan ellipse, demarking the edges of the tissue to be removed. Step 6135may comprise removal of the tissue comprising the shape of the ellipse.Step 6140 may comprise sewing fascia together to take the stress off ofthe skin when the edges of the skin are sewn together. Step 6145 maycomprise closing wounds or surface incisions via glues, staples,adhesive skin closure strips, and/or sutures.

Modification of localized cutaneous neurologic symptoms. E.g., localizeditching or burning. E.g., Notalgia paresthetica is an intense localizeditching area usually on the back. Dissecting the skin in the NP area aswell as around it may denervate or alter the neurologic pattern in areathus may provide relief. Post zoster neuralgia is an often painfulcondition that may feel like it is coming from the skin in patients whohave suffered from shingles. Dissecting the skin in the post zosterneuralgia area as well as around it may denervate or alter theneurologic pattern in area thus may provide relief. Other itching andpainful conditions of the skin possibly related to neurologicalterations may be improved by dissection with TD.

It will be understood by those having skill in the art that changes maybe made to the details of the above-described embodiments withoutdeparting from the underlying principles presented herein. For example,any suitable combination of various embodiments, or the featuresthereof, is contemplated.

Any methods disclosed herein comprise one or more steps or actions forperforming the described method. The method steps and/or actions may beinterchanged with one another. In other words, unless a specific orderof steps or actions is required for proper operation of the embodiment,the order and/or use of specific steps and/or actions may be modified.

Throughout this specification, any reference to “one embodiment,” “anembodiment,” or “the embodiment” means that a particular feature,structure, or characteristic described in connection with thatembodiment is included in at least one embodiment. Thus, the quotedphrases, or variations thereof, as recited throughout this specificationare not necessarily all referring to the same embodiment.

Similarly, it should be appreciated that in the above description ofembodiments, various features are sometimes grouped together in a singleembodiment, figure, or description thereof for the purpose ofstreamlining the disclosure. This method of disclosure, however, is notto be interpreted as reflecting an intention that any claim require morefeatures than those expressly recited in that claim. Rather, inventiveaspects lie in a combination of fewer than all features of any singleforegoing disclosed embodiment. It will be apparent to those havingskill in the art that changes may be made to the details of theabove-described embodiments without departing from the underlyingprinciples set forth herein.

Furthermore, the described features, components, structures, steps, orcharacteristics may be combined in any suitable manner in one or morealternative embodiments and/or implementations. In other words, any ofthe features, components, structures, steps, or characteristicsdisclosed in any one disclosed embodiment may be combined with features,components, structures, steps, or characteristics of other disclosedembodiments. The scope of the present invention should, therefore, bedetermined only by the following claims.

1. An electrosurgical lysing device, comprising: a lysing tip,comprising: a plurality of beads; at least one lysing member defining atleast one lysing segment extending between each pair of adjacent beads;and a tunnel extending at least partially through each of the pluralityof beads, wherein the at least one lysing member is positioned to extendat least partially through the tunnel to define the at least one lysingsegment between each pair of adjacent beads.
 2. The electrosurgicallysing device of claim 1, further comprising a support member configuredto facilitate coupling of the lysing tip to a surgical tool used tocontrol the lysing tip during a surgical procedure within a patient'sbody.
 3. A system comprising the electrosurgical lysing device of claim2, and further comprising a surgical tool configured to selectivelyengage the support member and deliver electrosurgical energy to the atleast one lysing member during a surgical procedure.
 4. The system ofclaim 3, wherein the surgical tool comprises at least one jaw, andwherein the at least one jaw is configured to selectively engage thesupport member.
 5. The system of claim 4, further comprising a slotformed in the at least one jaw, wherein the slot is configured toreceive at least a portion of the support member therethrough.
 6. Thesystem of claim 5, wherein a distal portion of the at least one jawprotrudes beyond the at least a portion of the support member such thatthe at least a portion of the support member is fully circumscribed bythe slot.
 7. The system of claim 4, wherein the surgical tool comprisesat least one of an opening and a projection, wherein the support membercomprises at least one of a projection and an opening configured to matewith the at least one of an opening and a projection of the surgicaltool to lock the lysing tip in place on the surgical tool during asurgical procedure.
 8. The system of claim 7, wherein the projectioncomprises a faceted surface such that, upon coupling the at least one ofa projection and an opening of the support member with the at least oneof an opening and a projection of the surgical tool, the lysing tip islocked in place relative to the surgical tool at a fixed rotationalorientation.
 9. A system comprising the electrosurgical lysing device ofclaim 1, further comprising a deployment assembly configured to allowfor selective repositioning between a delivery configuration and atreatment configuration, wherein the lysing tip further comprises asupport member configured to facilitate coupling of the lysing tip tothe deployment assembly, and wherein the support member comprises: adisposable portion coupled with the at least one lysing member and theplurality of beads; and a base portion detachably couplable with thedisposable portion and configured such that, following anelectrosurgical procedure using the lysing tip, the disposable portionmay be removed from the base portion and a new disposable portion, thenew disposable portion comprising a new at least one lysing member and anew plurality of beads, may be coupled with the base portion for asubsequent electrosurgical procedure.
 10. A system comprising theelectrosurgical lysing device of claim 1, further comprising a surgicaltool configured to selectively engage the lysing tip and deliverelectrosurgical energy to the at least one lysing member during asurgical procedure, wherein the lysing tip is configured to be coupledwith the surgical tool such that, while coupled with the lysing tip, adistal end of the surgical tool protruding distally beyond the at leastone lysing member has a shape that at least substantially mimics theshapes of each of the plurality of beads.
 11. The electrosurgical lysingdevice of claim 1, wherein the plurality of beads comprises a firstouter bead and a second outer bead positioned opposite from the firstouter bead, and wherein the lysing tip further comprises a graspingplate coupled with the at least one lysing member, wherein the graspingplate is configured to be selectively engaged by a surgical tool duringa surgical procedure within a patient's body.
 12. The electrosurgicallysing device of claim 1, wherein at least one of the plurality of beadscomprises a hole extending to the at least one lysing member, andwherein the at least one lysing member is coupled to each of theplurality of beads within each hole.
 13. The electrosurgical lysingdevice of claim 1, wherein the at least one lysing member comprises alysing rod extending at least partially through each of the plurality ofbeads, and wherein the lysing tip further comprises at least one spacerpositioned on the lysing rod so as to confine each of the plurality ofbeads to a predetermined location on the lysing rod.
 14. Theelectrosurgical lysing device of claim 1, wherein each of at least asubset of the plurality of beads comprises a plurality of facets formedthereon.
 15. The electrosurgical lysing device of claim 1, furthercomprising: a conductive shaft configured to be electrically coupledwith an electrosurgical device; and a insulating cover extending over aportion of the conductive shaft, wherein the at least one lysing memberextends through an opening formed in the conductive shaft such that abulbous projection extends beyond the at least one lysing member, andwherein the plurality of beads comprises a first outer bead and a secondouter bead positioned opposite from the first outer bead such that thebulbous projection is positioned between the first outer bead and thesecond outer bead and such that a first lysing segment is defined by theat least one lysing member in between the first outer bead and thebulbous projection and such that a second lysing segment is defined bythe at least one lysing member in between the second outer bead and thebulbous projection.
 16. A system for delivery of tissue modificationenergy during a surgical procedure, the system comprising: a tissuemodification tip comprising an energy window configured to deliverenergy therethrough for modification of patient tissue during a surgicalprocedure; a grasping pad; and a first instrument configured toselectively couple with the tissue modification tip, wherein the firstinstrument is configured to selectively couple with the tissuemodification tip at the grasping pad.
 17. The system of claim 16,wherein the energy window comprises an elongated energy window extendingalong at least one of an upper surface and a lower surface of the tissuemodification tip.
 18. The system of claim 17, wherein the tissuemodification tip comprises a plurality of bars extending across theelongated energy window, and wherein the plurality of bars is configuredto separate the elongated energy window into a plurality of isolatedenergy windows.
 19. An electrosurgical device configured for deploymentthrough a cannula comprising: a lysing tip configured for delivery ofelectrosurgical energy, wherein the lysing tip comprises: an energydelivery side configured to receive and deliver electrosurgical energyfor one or both of tissue dissection and modification; and anorientational-deployment side opposite from the energy delivery side,wherein the orientational-deployment side is configured to allow for thelysing tip to be repositioned between a delivery configuration in whichthe lysing tip can be positioned within a lumen of the cannula with theenergy delivery side facing an interior surface of the lumen and atreatment configuration in which the lysing tip is positioned outside ofthe cannula such that the energy delivery side extends at leastsubstantially perpendicular to an axis of the cannula; and a deploymentassembly coupled with the orientational-deployment side of the lysingtip, wherein the deployment assembly is configured to allow forselective repositioning between the delivery configuration and thetreatment configuration.
 20. The electrosurgical device of claim 19,wherein the lysing tip comprises: a plurality of beads; and at least onelysing member defining at least one lysing segment extending betweeneach pair of adjacent beads.
 21. The electrosurgical device of claim 20,wherein each of at least a subset of the plurality of beads isconfigured so as to allow for rotation of each respective bead of the atleast a subset of the plurality of beads about the at least one lysingmember.